Abstract
BackgroundBiliary system anatomical abnormalities can be preoperatively detected on magnetic resonance imaging; therefore, some presume that the number of bile duct injuries should decline. However, once a bile duct injury occurs, repair may be difficult. There are various ways to repair bile duct injuries, but successful repair may be exceptionally difficult.Case presentationA 72-year-old Japanese man underwent a pancreaticoduodenectomy due to a diagnosis of middle bile duct cancer. We had a complication of an isolated posterior segmental biliary obstruction when pancreaticoduodenectomy was performed. We conducted a drip infusion cholecystocholangiography-computed tomography test to determine the positional relationship between his bile duct and elevated jejunum. To secure the bile duct we punctured the bile duct under computed tomography guidance, and the hepaticojejunal anastomosis site was visualized by inserting an endoscope. We vibrated the bile duct wall by inserting a guide wire through a puncture needle and verified the vibrations with the endoscope. We observed a partially compressed elevated jejunal wall upon guide wire insertion; therefore, we could verify a puncture needle penetration into the elevated jejunum by endoscope on insertion. We also successfully inserted an 8.5-Fr pigtail catheter into the elevated jejunum. We removed all drains after percutaneously inserting an uncovered metallic stent. Our patient’s subsequent clinical course was unremarkable. He visits our institution as an out-patient and has had no stent occlusion even after 6 months.ConclusionsWhen repairing bile duct injuries, it is important to accurately determine the positional relationships between the injured bile duct and the surrounding organs.
Highlights
Biliary system anatomical abnormalities can be preoperatively detected on magnetic resonance imaging; some presume that the number of bile duct injuries should decline
Because biliary system anatomical abnormalities can be preoperatively detected on magnetic resonance imaging (MRI), some presume that the number of
We report on a case of successful establishment of internal bile duct drainage, into the elevated jejunum, against an isolated posterior segmental biliary obstruction after pancreaticoduodenectomy
Summary
Pancreaticoduodenectomy is one of the most difficult surgeries. The incidence of postoperative complications can be as high as 30–50%, depending on the case [1,2,3,4]. We. Izumi et al Journal of Medical Case Reports (2018) 12:156 observed stenosis in the middle bile duct on a preoperative endoscopic retrograde cholangiopancreatography (ERCP) image (Fig. 1), whereas class V adenocarcinoma was detected by biliary abrasive cytology. On computed tomography (CT) we observed abscess formation with suspected bile leakage around the hepaticojejunal site and posterior segmental bile duct dilatation (Fig. 2). During contrast radiography with PTBD, only the posterior segmental branch was visualized, but there was no bile leakage into the elevated jejunum (Fig. 3). We completed contrast radiography from the hepaticojejunal anastomosis site with the use of an endoscope, and only the anterior segmental branch and left branch were visualized (Fig. 4). We vibrated the bile duct wall by inserting a guide wire through a puncture needle, and verified the vibrations with the endoscope. We found a partially compressed elevated jejunal wall upon guide wire insertion; we could verify a puncture needle penetration into the elevated jejunum by endoscope
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