A case of successful percutaneous transhepatic retrograde biliary drainage (PTRBD) for bile duct stenosis with biliary leakage after hepatic resection

Abstract

We report successful percutaneous transhepatic retrograde biliary drainage (PTRBD) in a patient with a biliary fistula following hepatic resection, after endoscopic retrograde biliary drainage (ERBD) proved difficult. A 71-year-old man presented with a postoperative biliary fistula with abscess formation following extended left lobectomy for hepatocellular carcinoma, and was diagnosed with an isolated biliary fistula caused by stenosis of the posterior sector bile ducts. We attempted stent placement, but ERBD was difficult following total gastrectomy; percutaneous transhepatic biliary drainage (PTBD) was unsuccessful. We inserted a catheter through the abscess cavity to the terminus of the right posterior bile duct (B6a). Using a relatively stiff guidewire, we perforated the peripheral wall of the bile duct and hepatic parenchyma, advancing to the abdominal cavity inferior to the right diaphragm. We extracted the guidewire, leaving an indwelling catheter in the bile duct. This technique can be considered as a PTRBD variant.