Spontaneous Cysto-biliary Communication and Its Endoscopic Management

Background: Spontaneous communication of walled off pancreatic necrosis (WOPN) and CBD is an entity not described in the literature. Its identification and management are presented here.

Methods: A middle-aged lady was managed for moderately severe biliary pancreatitis in another center and had undergone cholecystectomy for the same. She presented to us with a large symptomatic WOPN. We did EUS-guided drainage using a fully covered NAGI stent. Two days after the procedure, when we entered the WOPN, we found lot of bilious secretions in the cavity along with the debris. We did direct endoscopic necrosectomy and after completion, an opening (10 mm in diameter) was noted in the CBD through which the plastic biliary stent could be seen. We did ERCP and cholangiogram showed leak from distal CBD. We placed four double pigtail plastic stents (8F 8 cm) in the CBD and left them for 6 weeks.

Results: She was asymptomatic during follow-up and after 6 weeks, CECT abdomen showed complete resolution of WOPN. ERCP and removal of multiple plastic stents was done. Cholangiogram showed complete closure of the leak of CBD.

Conclusion: WOPN fistulizing into the CBD is an entity not reported in the literature. It can be managed by a fully covered biliary SEMS but we preferred to use multiple plastic biliary stents considering the risk of migration of SEMS. We achieved complete closure of the biliary leak with endoscopic management.

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Artikel online veröffentlicht:
22. April 2024