• Skip to primary navigation
  • Skip to main content
  • Skip to primary sidebar
  • Skip to footer

SAGES

Reimagining surgical care for a healthier world

  • Home
    • COVID-19 Annoucements
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Who is SAGES?
    • SAGES Mission Statement
    • Strategic Plan, 2020-2023
    • Committees
      • Request to Join a SAGES Committee
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Full Committee Rosters
      • SAGES Past Presidents
    • Donate to the SAGES Foundation
    • Awards
      • George Berci Award
      • Pioneer in Surgical Endoscopy
      • Excellence In Clinical Care
      • International Ambassador
      • IRCAD Visiting Fellowship
      • Social Justice and Health Equity
      • Excellence in Community Surgery
      • Distinguished Service
      • Early Career Researcher
      • Researcher in Training
      • Jeff Ponsky Master Educator
      • Excellence in Medical Leadership
      • Barbara Berci Memorial Award
      • Brandeis Scholarship
      • Advocacy Summit
      • RAFT Annual Meeting Abstract Contest and Awards
  • Meetings
    • 2022 NBT Innovation Weekend
    • SAGES Annual Meeting
      • 2023 Scientific Session Call For Abstracts
      • 2023 Emerging Technology Call For Abstracts
    • SAGES 2021 Annual Meeting
    • CME Claim Form
    • Industry
      • Advertising Opportunities
      • Exhibit Opportunities
      • Sponsorship Opportunities
    • Future Meetings
    • Past Meetings
      • SAGES 2021
      • SAGES 2020
      • SAGES 2019
      • SAGES 2018
    • Related Meetings Calendar
  • Join SAGES!
    • Membership Benefits
    • Membership Applications
      • Active Membership
      • Affiliate Membership
      • Associate Active Membership
      • Candidate Membership
      • International Membership
      • Medical Student Membership
    • Member News
      • Member Spotlight
      • Give the Gift of SAGES Membership
  • Patients
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Patient Information Brochures
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find a SAGES Member
  • Publications
    • SAGES Stories Podcast
    • SAGES Clinical / Practice / Training Guidelines, Statements, and Standards of Practice
    • Patient Information Brochures
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • SCOPE – The SAGES Newsletter
    • COVID-19 Annoucements
    • Troubleshooting Guides
  • Education
    • OpiVoid.org
    • SAGES.TV Video Library
    • Safe Cholecystectomy Program
      • Safe Cholecystectomy Didactic Modules
    • Masters Program
      • SAGES Facebook Program Collaboratives
      • Acute Care Surgery
      • Bariatric
      • Biliary
      • Colorectal
      • Flexible Endoscopy (upper or lower)
      • Foregut
      • Hernia
      • Robotics
    • Educational Opportunities
    • HPB/Solid Organ Program
    • Courses for Residents
      • Advanced Courses
      • Basic Courses
    • Video Based Assessments (VBA)
    • Robotics Fellows Course
    • MIS Fellows Course
    • Facebook Livestreams
    • Free Webinars For Residents
    • SMART Enhanced Recovery Program
    • SAGES OR SAFETY Video
    • SAGES at Cine-Med
      • SAGES Top 21 MIS Procedures
      • SAGES Pearls
      • SAGES Flexible Endoscopy 101
      • SAGES Tips & Tricks of the Top 21
  • Opportunities
    • SAGES Fellowship Certification for Advanced GI MIS and Comprehensive Flexible Endoscopy
    • Foregut Fellowship Certification
    • SAGES Research Opportunities
    • Fundamentals of Laparoscopic Surgery
    • Fundamentals of Endoscopic Surgery
    • Fundamental Use of Surgical Energy
    • Job Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
  • Search
    • Search All SAGES Content
    • Search SAGES Guidelines
    • Search the Video Library
    • Search the Image Library
    • Search the Abstracts Archive
  • Blog
    • COVID-19
    • Notes from the Battlefield
    • A (Positive) Way Forward
    • President Posts
    • All Blog Posts
  • Log In

Percutaneous Transhepatic and Transjejunal Rendezvous Procedure for Treatment of Complete Dehiscence of the Bilioenteric Anastomosis

Martin G Rosenthal, MD, Adam Rogers, MD, Travis Edelstein, DO, Abubaker Ali, MD, Ziad T Awad, MD, FACS. University of Florida College of Medicine, Jacksonville

Introduction: Pancreaticoduodenectomy (PD) is the standard of care for patients with resectable malignant diseases of the periampullary region. Leaks from the hepaticojejunostomy (HJ) are estimated to range between 2-8%. Although leaks from the pancreaticojejunostomy (PJ) are more common than those from the HJ the impact of these complications can be equally severe, and the management nearly as complex. Despite this, biliary leaks from the HJ following PD has been underreported in the literature compared to leaks from PJ. Interventional radiologists (IR) have become a critical part of the team caring for patients with complications following PD.  We report on a patient in whom PD was complicated by a complete disruption of the HJ anastomosis treated percutaneously by a novel IR intervention.

Case Report: A 31 year old female with a significant history of Familial Adenomatous Polyposis and Gardner’s syndrome presented for evaluation of multiple, diffuse, duodenal polyps, including the periampullary region that were found to harbor low grade dysplasia. The patient underwent a PD in the standard open fashion. On post-operative day 5 the patient became unstable and was transferred to the Intensive Care Unit. She was found to have a biliary leak related to a complete dehiscence of the HJ anastomosis.  Percutaneous transhepatic cholangiography (PTC) was performed demonstrating a complete dehiscence of the HJ. Retrograde transjejunal access was obtained percutaneously and subsequently a guidewire was advanced via this access and snared through the PTC access for definitive internal/external drainage via an antegrade approach. Serial cholangiograms demonstrated a progressive decrease in the severity of the bile leak as well as decreased output from the perihepatic percutaneous drains. The final cholangiogram performed two months after the initial operation demonstrated no residual leak and free flow of contrast through the previously dehisced hepaticojejunostomy.

Discussion: According to the International Study Group on Pancreatic Fistula model our patient had a grade C bile leak which was successfully treated via an antegrade percutaneous transhepatic-transjejunal approach. To our knowledge this is the first case to describe the utilization of IR to salvage a completely disrupted HJ anastomosis following PD, therefore, avoiding the high morbidity associated with reoperation. The field of IR is rapidly expanding with numerous applications that have been proven to provide a less invasive approach in managing post-surgical complications.

Conclusion: Complete dehiscence of the hepaticojejunostomy anastomosis can be successfully managed with a novel IR intervention reducing the morbidity of reoperation.

 

Figure 4: Final Cholangiogram 2 months status post WhippleFigure 1: PTC demonstrating bilioenteric dehiscenceFigure 2: Percutaneous Transhepatic and Transjejunal AccessFigure 3: Intra/Extrahepatic Biliary Drain

261

Share this:

  • Twitter
  • Facebook
  • LinkedIn
  • Pinterest
  • WhatsApp
  • Reddit

Related

« Return to SAGES 2016 abstract archive

Our Mission

Innovate, educate and collaborate to improve patient care.

Recently, on SAGES…

Surgery is Safer with Vaccination 1

Addressing Religious Concerns About COVID-19 Vaccine

This may be a difficult subject matter for you and your patient to talk about.  Be assured, all major organized religious groups encourage and recommend the COVID-19 vaccine. Listed below are references and websites you can direct your patient towards to help them make an informed decision with regards to their religious concerns against the […]

SAGES Statement on AAPI Violence

The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) stands in solidarity with the Asian American and Pacific Islander (AAPI) community. In the summer of 2020, SAGES released a statement condemning the violence, racism, and hatred toward the Black community in the wake of George Floyd and Breonna Taylor’s murders. It is with great sorrow […]

Free SAGES Webinar: Lessons from COVID on Living and Thriving as Surgeons

SAGES recognizes that the COVID-19 pandemic has had a big impact on surgical practice and in surgeon wellness. SAGES’ Reimagining the Practice of Surgery Taskforce will present “Finding the Opportunities: Lessons from COVID and How We Live and Thrive as Surgeons”  to look at ways in which innovative leadership at various levels may help transform […]

Contact SAGES

Society of American Gastrointestinal and Endoscopic Surgeons
11300 W. Olympic Blvd Suite 600
Los Angeles, CA 90064 USA
[email protected]
Tel: (310) 437-0544

Find Us Around the Web!

  • Facebook
  • Twitter
  • YouTube

Important Links

SAGES 2022 Meeting Information

Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

SAGES Manuals

 

  • taTME Study Info
  • Foundation
  • SAGES.TV
  • MyCME
  • Educational Activities

Copyright © 2022 Society of American Gastrointestinal and Endoscopic Surgeons