A treated case of postoperative isolated bile leakage using a combined percutaneous-endoscopic rendezvous technique

Abstract

A patient who had underwent central bisectionectomy developed postoperative isolated bile leakages. ERC and PTC revealed a loss of the hilum with interruption of the left and right bile ducts as well as common bile duct (CBD). Furthermore, PTC revealed a biloma concomitant with peripheral bile ducts. To reconnect the biliary system, rendezvous technique was planned. PTBD was inserted from peripheral sides. The guide wire penetrated bluntly from peripheral duct into the biloma. Then, obstruction of CBD was also penetrated by guide wire under ERC. The guide wire from PTBD was grasped and pulled through duodenum. PTBD tube was inserted along to the guide wire and internal biliary drainage succeeded. We report a case of refractory peripheral bile leakage with complete hepatic hilum biliary strictures treated by a combined percutaneous-endoscopic rendezvous technique resulting in successful internal biliary drainage.