Monday Poster Session
Category: Endoscopy Video Forum
Rahil Desai, DO
Franciscan Health Olympia Fields
Westlake, OH
A 64 year-old female with a past medical history of sigmoid colon cancer s/p bowel resection with solitary metastasis to the right lobe of the liver presents with jaundice and early satiety. The patient underwent right hepatectomy, and unfortunately during surgery, the left hepatic duct was clipped and transected. Attempts at an ERCP were unsuccessful, and the patient was referred for percutaneous transhepatic biliary drain (PTBD). The hepatic ducts were completely collapsed and placement of a PTBD was unsuccessful despite numerous attempts. It was decided to attempt an EUS guided hepaticoduodenostomy. The left hepatic duct was punctured near the hilum using a 19G needle and a guidewire was passed. The tract was dilated using 7F Soehendra dilator, followed by balloon dilation to 4mm. An (8mm x 8cm) Viabil Stent was placed with excellent drainage. The patient's JP drain output dropped from 400cc per day to 25cc in the first 24 hours. The drain was eventually removed in one week, and the patient has continued to do well with the newly created hepaticoduodenostomy.
IBDI during surgery can have severe complications, often requiring liver transplantation or hepaticojejunostomy. Our video presentation demonstrates EUS guided hepaticoduodenostomy when ERCP and PTBD are unsuccessful at obtaining access to a collapsed biliary system.