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DOI: 10.1055/a-2160-5462
Post-cholecystectomy biliary leakage mimicking a neoplastic lesion: contribution of cholangioscopy in diagnosis and endoscopic treatment
Keywords
Strictures - Cholangioscopy - Pancreatobiliary (ERCP/PTCD) - Diagnostic ERC - Tissue diagnosis - ERC topicsWe report the case of a 70-year-old woman with no relevant medical history, who was referred to our department for jaundice and liver disfunction 1 month after cholecystectomy ([Fig. 1]). Contrast-enhanced computed tomography of the abdomen and the pelvis showed dilatation of the intrahepatic bile ducts, upstream of the biliary convergence, with an infiltration of the hepatic hilum. Magnetic resonance imaging confirmed the presence of biliary stenosis at the level of the convergence, together with circumferential thickening of the wall of the upper part of the main bile duct, extending over 2 cm ([Fig. 2]).
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We performed endoscopic ultrasound, which revealed a hypoechoic area at the level of the biliary convergence, with intraluminal hyperechoic material, mimicking stones. Then, we performed endoscopic retrograde cholangiopancreatography (ERCP), which did not result in satisfactory opacification of the biliary tract ([Fig. 3]). After endoscopic sphincterotomy, we used a single-operator cholangioscope (SOC) to characterize the biliary damage ([Video 1]). A stone located in the upper part of the main bile duct was extracted. Then, SOC revealed a lateral wound of the main bile duct, complicated by a bilioma, within which a surgical clip was found. Stenosis of the common bile duct was associated with this biliary leakage. A guidewire was placed under SOC control and a 10F, 12-cm plastic biliary stent was placed ([Fig. 4]) [1] [2] [3].
Qualität:
![](https://www.thieme-connect.de/media/10.1055-s-00025476/202309/thumbnails/10-1055-a-2160-5462_21612700.jpg)
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The patient’s post-endoscopic course was rapidly favorable. Three months later, a new ERCP was performed to remove the prosthesis and to confirm healing of the biliary wound, with persistence of stenosis. A balloon dilatation was performed, followed by insertion of two 8.5F, 12-cm plastic stents for calibration ([Fig. 5]) [4].
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We illustrate here the use of SOC, as a combined diagnostic and therapeutic means, when the imaging potentially suggested malignancy. Thus, SOC must be democratized in management of complex biliary duct pathology.
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Conflict of Interest
The authors declare that they have no conflict of interest.
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References
- 1 Nagra N, Klair JS, Jayaraj M. et al. Biliary sphincterotomy alone versus biliary stent with or without biliary sphincterotomy for the management of post-cholecystectomy bile leak: a systematic review and meta-analysis. Dig Dis 2022; 40: 810-815
- 2 Rio-Tinto R, Canena J. Endoscopic treatment of post-cholecystectomy biliary leaks. GE Port J Gastroenterol 2021; 28: 265-273
- 3 de’Angelis N, Catena F, Memeo R. et al. 2020 WSES guidelines for the detection and management of bile duct injury during cholecystectomy. World J Emerg Surg 2021; 16: 30
- 4 Seleem WM, Hanafy AS, Abd-Elsalam S. et al. Impact of laparoscopic cholecystectomy on the complexity of endoscopic retrograde cholangiopancreatography. Eur J Gastroenterol Hepatol 2022; 34: 142-145
Correspondence
Publikationsverlauf
Eingereicht: 11. Mai 2023
Angenommen nach Revision: 04. Juli 2023
Artikel online veröffentlicht:
06. Oktober 2023
© 2023. The Author(s). 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/).
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References
- 1 Nagra N, Klair JS, Jayaraj M. et al. Biliary sphincterotomy alone versus biliary stent with or without biliary sphincterotomy for the management of post-cholecystectomy bile leak: a systematic review and meta-analysis. Dig Dis 2022; 40: 810-815
- 2 Rio-Tinto R, Canena J. Endoscopic treatment of post-cholecystectomy biliary leaks. GE Port J Gastroenterol 2021; 28: 265-273
- 3 de’Angelis N, Catena F, Memeo R. et al. 2020 WSES guidelines for the detection and management of bile duct injury during cholecystectomy. World J Emerg Surg 2021; 16: 30
- 4 Seleem WM, Hanafy AS, Abd-Elsalam S. et al. Impact of laparoscopic cholecystectomy on the complexity of endoscopic retrograde cholangiopancreatography. Eur J Gastroenterol Hepatol 2022; 34: 142-145
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