Download PDF
CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2023; 33(03): 416-419
DOI: 10.1055/s-0043-1764294
Case Report

Combined Bile Duct Ablation and Fistulous Tract Embolization Using N-Butyl Cyanoacrylate to Manage a Biliary-Cutaneous Fistula Following Percutaneous Transhepatic Biliary Drainage (PTBD) for Hilar Cholangiocarcinoma

Ranjan Kumar Patel 
1   Department of Radiodiagnosis, All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, Odisha, India
,
Tara Prasad Tripathy 
1   Department of Radiodiagnosis, All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, Odisha, India
,
Alamelu Alagappan 
1   Department of Radiodiagnosis, All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, Odisha, India
,
Tanmay Dutta
2   Department of Surgical Gastroenterology, All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, Odisha, India
,
Hemant Kumar Nayak
3   Department of Medical Gastroenterology, All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, Odisha, India
,
Bramhadatta Pattnaik
2   Department of Surgical Gastroenterology, All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, Odisha, India
› Author Affiliations Funding None.
› Further Information
Also available at
   Permissions and Reprints

Abstract

Biliary fistula and bile leak are known complications following hepatobiliary surgery, trauma, and percutaneous biliary interventions. In the case of an isolated biliary system with a prolonged indwelling percutaneous transhepatic biliary drainage (PTBD) catheter, a biliary-cutaneous fistula (BCF) may develop after catheter blockage or its accidental slippage. Due to the absence of internal drainage, secreted bile flows through the matured PTBD tract to form a fistula. If left untreated, chronic BCF will result in malabsorption, infection, and delayed wound healing. Here, we report a case of left-sided BCF following prolonged PTBD for Bismuth type II cholangiocarcinoma (metastatic disease), which was initially managed by bile duct ablation using N-butyl cyanoacrylate. The patient further needed fistulous tract embolization to obliterate the BCF.

Keywords

bile leak - biliary-cutaneous fistula - cholangiocarcinoma - N-Butyl cyanoacrylate - percutaneous transhepatic biliary drainage

Ethical Approval

The internal ethical committee approved this article.


Availability of Data and Materials

The data sets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.




Publication History

Article published online:
15 March 2023

© 2023. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Bae JH, Kim GC, Ryeom HK, Jang YJ. Percutaneous embolization of persistent biliary and enteric fistulas with Histoacryl. J Vasc Interv Radiol 2011; 22 (06) 879-883
    CrossrefPubMedSearch in Google Scholar
  • 2 Kusano T, Kida H, Nishiwaki Y. et al. Percutaneous sclerotherapy for intractable external biliary fistula after hepatectomy. Int Surg 2003; 88 (02) 72-75
    PubMedSearch in Google Scholar
  • 3 Vu DN, Strub WM, Nguyen PM. Biliary duct ablation with N-butyl cyanoacrylate. J Vasc Interv Radiol 2006; 17 (01) 63-69
    CrossrefPubMedSearch in Google Scholar
  • 4 Bottari A, Silipigni S, Stagno A, Caloggero S. Bilio-cutaneous fistula obliteration with NBCA. Indian J Radiol Imaging 2019; 29 (03) 310-312
    Thieme ConnectPubMedSearch in Google Scholar
  • 5 Alberto S, Salvatore S, Marco T. et al. Embolization of extrahepatic biliary leakage using NBCA. Radiol Case Rep 2021; 16 (06) 1315-1319
    CrossrefPubMedSearch in Google Scholar
  • 6 Ierardi AM, Fontana F, Mangini M. et al. Use of Amplatzer vascular plug to treat a biliary cutaneous fistula. Korean J Radiol 2013; 14 (05) 801-804
    CrossrefPubMedSearch in Google Scholar
  • 7 Kubo N, Harimoto N, Shibuya K. et al. Successful treatment of isolated bile leakage after hepatectomy combination therapy with percutaneous transhepatic portal embolization and bile duct ablation with ethanol: a case report. Surg Case Rep 2018; 4 (01) 61
    CrossrefPubMedSearch in Google Scholar
  • 8 Ito A, Ebata T, Yokoyama Y. et al. Ethanol ablation for refractory bile leakage after complex hepatectomy. Br J Surg 2018; 105 (08) 1036-1043
    CrossrefPubMedSearch in Google Scholar
  • 9 Sakamoto K, Tamesa T, Yukio T, Tokuhisa Y, Maeda Y, Oka M. Risk factors and managements of bile leakage after hepatectomy. World J Surg 2016; 40 (01) 182-189
    CrossrefPubMedSearch in Google Scholar
  • 10 Lauterio A, Slim A, Aseni P. et al. Percutaneous transhepatic bile duct ablation with N-butyl cyanoacrylate in the treatment of a biliary complication after split liver transplantation. J Transplant 2009; 2009: 824803
    CrossrefPubMedSearch in Google Scholar
  • 11 Hai S, Tanaka H, Takemura S, Sakabe K, Ichikawa T, Kubo S. Portal vein embolization for an intractable bile leakage after hepatectomy. Clin J Gastroenterol 2012; 5 (04) 287-291
    CrossrefPubMedSearch in Google Scholar
  • 12 Matsubara S, Nakagawa K, Suda K, Otsuka T, Oka M, Nagoshi S. Practical tips for safe and successful endoscopic ultrasound-guided hepaticogastrostomy: a state-of-the-art technical review. J Clin Med 2022; 11 (06) 1591
    CrossrefPubMedSearch in Google Scholar