Massimo Venturini MD, Presenter: Nothing to Disclose

Francesco Aldo De Cobelli MD, Abstract Co-Author: Nothing to Disclose

Stefano Cappio MD, Abstract Co-Author: Nothing to Disclose

Marco Salvioni, Abstract Co-Author: Nothing to Disclose

Giulia Agostini, Abstract Co-Author: Nothing to Disclose

Alessandro Del Maschio MD, Abstract Co-Author: Nothing to Disclose

To evaluate technique, feasibility, complications, and clinical outcome of percutaneous biliary drainage in 30 patients with undilated biliary ducts and normal bilirubin levels affected by biliary fistula due to pancreatobiliary surgical treatment.  

From 2006 to 2012, Percutaneous Transhepatic Colangiography (PTC) and placement of a percutaneous biliary drainage (8-French) was attempted in 30 patients affected by biliary fistula, demonstrated by the presence of bile in abdominal surgical drainage, with bilirubin normal levels and ultrasonographic evidence of undilated biliary ducts. Under ultrasonographic (and fluoroscopic) guidance, the puncture attempt with Chiba needle (21G) was performed using a right approach puncturing along the course of the sixth segment portal branch, or a left approach in case of aerobilia and adequate volume of the left hepatic lobe.  

PTC was successfully performed in 28/30 patients (21 cases with right approach, 7 with left approach) with radiological demonstration of biliary fistula (direct opacification of the fistula adjacent to the biliary-digestive anastomosis and fluroscopic demonstration of contrast material in the surgical drainage). Biliary drainage was placed in 27/30 patients (90%) at first attempt, in 1/30 patients (3.3%) at second attempt two days later, placing in 23 patients an external-internal drainage, in 5 patients an external drainage, obtaining complete resolution of the fistula in all cases. No periprocedural complications were recorded. In 2/30 patients, biliary drainage couldn't be placed: surgical retreatment was necessary in one case while in the other case biliary fistula spontaneously resolved.  

Percutaneous biliary drainage under ultrasonographic/fluoroscopic guidance in patients with undilated biliary ducts affected by biliary fistula is feasible, effective, without significant periprocedural complications and represents the first choice of treatment; furthermore PTC is an accurate tool to confirm the diagnosis of biliary fistula after pancreatobiliary surgical treatment  

PTC and percutaneous biliary drainage represent the first therapeutic option in case of biliary fistula due to pancreatobiliary surgery.

Venturini, M, De Cobelli, F, Cappio, S, Salvioni, M, Agostini, G, Del Maschio, A, Biliary Drainage in 30 Patients with Undilated Bile Ducts Affected by Biliary Fistula due to Pancreatobiliary  Surgical Treatment: Technique, Feasibility, Complications, and Clinical Outcome  .  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13027569.html