Adel Alhaj Saleh, MD, MRCS, Edwin Onkendi, MBChB. Texas Tech University Health Sciences Center
The patient is a 53-year-old female who was transferred to us from another instituition. Two weeks ago, she presented with abdominal pain and work-up showed a large common bile duct stone. She was seen by a gastroenterologist locally who performed ERCP, but was unable to retrieve the stone. He therefore placed a plastic bile duct stent around it. The patient returned two days ago with abdominal pain, hematemesis and melanotic stools. A CT angiogram of the abdomen was obtained and showed that the proximal end of the common bile duct stent had its barb abutting on the right hepatic artery with possible erosion. The patient also had hemobilia and had a 2-gram drop in hemoglobin. Given the above, the patient was transferred to us for further care. She underwent repeat ERCP and removal of the previous bile duct stent and placement of a covered metal stent. During this, she was found to have ongoing bleeding into the bile duct; therefore, the decision was made to proceed to the operating room for robotic, possible open, takedown of the fistula and repair.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 96061
Program Number: V031
Presentation Session: HPB Videos
Presentation Type: Video