Post written by Arjun R. Sondhi, MD, from the Department of Internal Medicine, Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan.
An 87-year-old man who suffered a complete common bile duct (CBD) transection after a cholecystectomy presented to our institution for care. To treat his bile leak, we used a combined interventional radiology approach (percutaneous transhepatic biliary drain) and endoscopic approach (ERCP with cholangioscopy) to recanalize the bile duct and avoid long-term percutaneous biliary drainage or a significant surgical intervention. A fully covered self-expanding metal stent was placed as a long-term therapy during this multidisciplinary approach.
Inadvertent complete CBD transection during hepatobiliary surgery is quite uncommon. Patients often require surgical biliary bypass or long-term percutaneous biliary drainage, both of which carry additional morbidity and can negatively impact quality of life.
Complete CBD transection is not a lost cause for a therapeutic endoscopist but certainly represents a technical and cognitive challenge which should include a multi-disciplinary approach. A combined case with interventional radiology will be required for biliary recanalization in most patients.
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