Seung Hoon Shin, MD, Ariel Klevan, MD, Christopher Fernandez, MD, Jose M Martinez, MD, FACS. Division of Laparoendoscopic and Bariatric Surgery, Dewitt-Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA.
Common bile duct (CBD) injury during surgical procedures is a serious complication. Partial injury can usually be managed by a combination of percutaneous or endoscopic techniques. However, the management of complete transection of the CBD is very challenging. There are small case series of non-surgical management of complete CBD transaction during laparoscopic cholecystectomy. In this particular case, a 55 year-old female patient had multiple operations due to malignant pheochromocytoma with liver metastases. Her surgery was complicated by a complete CBD transection during right hepatectomy. A biloma was managed with image-guided percutaneous drainage. However both attempts of percutaneous transhepatic cholangiography (PTC) and endoscopic retrograde cholangiopancreatography (ERCP) for placement of a CBD stent were unsuccessful, as the native CBD was partially resected during the injury. A rendezvous procedure, in which a guidewire was placed through the distal CBD and into a biloma by ERCP, and simultaneously snared via a PTC approach allowed for a biliary-duodenal catheter to be placed successfully and achieve continuity of the patient’s biliary tree and the patient was discharged the next day. In 2 months interventional radiologist placed a metal stent which was removed by the endoscopist 4 months later. Internal and External biliary catheter was gradually upsized up to 12 Fr and eventually removed in 9 months after the original procedure. During the 9 month-period of the follow-up, the patient was stable and surgical procedure was not required.