論文

国際誌
2020年12月3日

Extraluminal recanalization for postoperative biliary obstruction using transseptal needle.

Surgical case reports
  • Hiroki Horinouchi
  • ,
  • Eisuke Ueshima
  • ,
  • Keitaro Sofue
  • ,
  • Shohei Komatsu
  • ,
  • Takuya Okada
  • ,
  • Masato Yamaguchi
  • ,
  • Takumi Fukumoto
  • ,
  • Koji Sugimoto
  • ,
  • Takamichi Murakami

6
1
開始ページ
304
終了ページ
304
記述言語
英語
掲載種別
研究論文(学術雑誌)
DOI
10.1186/s40792-020-01080-9

BACKGROUND: Postoperative biliary strictures are commonly related to accidental bile duct injuries or occur at the site of biliary anastomosis. The first-line treatment for benign biliary strictures is endoscopic therapy, which is less invasive and repeatable. However, recanalization for biliary complete obstruction is technically challenging to treat. The present report describes a successful case of treatment by extraluminal recanalization for postoperative biliary obstruction using a transseptal needle. CASE PRESENTATION: A 66-year-old woman had undergone caudal lobectomy for the treatment of hepatocellular carcinoma. The posterior segmental branch of the bile duct was injured and repaired intraoperatively. Three months after the surgery, the patient had developed biliary leakage from the right hepatic bile duct, resulting in complete biliary obstruction. Since intraluminal recanalization with conventional endoscopic and percutaneous approaches with a guidewire failed, extraluminal recanalization using a transseptal needle with an internal lumen via percutaneous approach was performed under fluoroscopic guidance. The left lateral inferior segmental duct was punctured, and an 8-F transseptal sheath was introduced into the ostium of right hepatic duct. A transseptal needle was advanced, and the right hepatic duct was punctured by targeting an inflated balloon that was placed at the end of the obstructed right hepatic bile duct. After confirming successful puncture using contrast agent injected through the internal lumen of the needle, a 0.014-in. guidewire was advanced into the right hepatic duct. Finally, an 8.5-F internal-external biliary drainage tube was successfully placed without complications. One month after the procedure, the drainage tube was replaced with a 10.2-F drainage tube to dilate the created tract. Subsequent endoscopic internalization was performed 5 months after the procedure. At the 1-year follow-up examination, there was no sign of biliary obstruction and recurrence of hepatocellular carcinoma. CONCLUSIONS: Recanalization using a transseptal needle can be an alternative technique for rigid biliary obstruction when conventional techniques fail.

リンク情報
DOI
https://doi.org/10.1186/s40792-020-01080-9
PubMed
https://www.ncbi.nlm.nih.gov/pubmed/33270174
PubMed Central
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7714871
ID情報
  • DOI : 10.1186/s40792-020-01080-9
  • PubMed ID : 33270174
  • PubMed Central 記事ID : PMC7714871

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