Three cases of benign biliary stricture, obstruction or separation following hepaticojejunostomy: Transhepatic approach for internal anastomotic stenting using a double slide C arm and real-time CT

Abstract

We performed biliary stenting for anastomotic stricture, obstruction or transection of hepaticojejunostomy which was possible to turn in a free axis using a double slide C arm and real-time CT. Case 1: A case of separation of hepaticojejunostomy after extended right hepatectomy. Because the supersonic wave was interrupted by bowel gas, ultrasound-guided PTCD was difficult. We punctured the bile duct directly under real-time CT guidance and performed stenting via adjacent abscess under visualization with X-rays. Case 2: Complete occlusion of the anastomosis after extended right hepatectomy. We punctured the lumen of the jejunum directly from the PTCD route and performed stenting under visualization with X-rays. Case 3: Anastomotic stricture after extended left hepatectomy. We used X-rays image to determine the release points for the magnets or Yamanouchi magnet anastomosis. In all three cases, biliary stenting was successful. Advances in transhepatic approach sing a double slide C arm and real-time CT have facilitated obtaining a good 3 dimensional information and allow an alternative low stress option for the stenting procedure.