A Case of Intractable Isolated Bile Leakage Treated with Ethanol Ablation

Abstract

A 58-year-old man with hepatic dysfunction was referred to our hospital. Imaging studies, including contrast-enhanced computed tomography (CT), showed hepatocellular carcinoma in S4. Left hemihepatectomy was performed after portal vein embolization. Abdominal drains were removed on postoperative day (POD) 16 after disappearance of minor bile leakage, but fluid was collected on the liver resection surface, and CT-guided drainage was carried out. Fistulography on POD32 showed the severed B5c bile duct. Although endoscopic retrograde biliary drainage was performed twice, the condition did not improve. Ethanol ablation therapy of the B5c bile duct was thus attempted, but it was difficult to insert a single balloon catheter selectively into the bile duct. Thus, a multi-hole, double-balloon catheter, which allowed selective and safe biliary ethanol injection by sandwiching the cut stump of the bile duct between two balloons, was used. Bile discharge from the drain decreased immediately, and the drain was removed one week after the ablation therapy. A multi-hole, double-balloon catheter could be a useful tool for selective ethanol injection into an intractable isolated bile leakage after hepatectomy.