Successful internalization of a chronic biliary cutaneous fistula after liver transplantation: deepithelializing the fistula tract.
Biliary cutaneous fistulas are uncommon sequelae after biliary surgery and can be a source of significant morbidity. We describe a liver recipient who developed a biliary cutaneous fistula secondary to hepatic artery thrombosis; this subsequently drained for over 7 years. Through a novel approach, using the transabdominal fistula tract as a conduit, the fistula skin opening was deepithelialized and anastomosed to a jejunal loop, internally draining the tract. For over 7 years postoperatively, this internal drainage procedure has continued to function effectively. This approach may have value in internalizing longstanding biliary cutaneous fistulas in well-selected patients in whom there is no existing biliary ductal system or the existing system anatomically does not lend itself to restoration of functional internal drainage through conventional approaches.
Morris
David
D
Division of Plastic and Reconstructive Surgery, Department of Surgery, Henry Ford Hospital, 2799 West Grand Blvd., Detroit, MI 48202-2689, USA.
Ladizinsky
Daniel
D
Abouljoud
Marwan
M
D001658:Biliary Fistula / Q000209:etiology / Q000601:surgery*; D001662:Biliary Tract Surgical Procedures / Q000379:methods; D002908:Chronic Disease; D017577:Cutaneous Fistula / Q000209:etiology / Q000601:surgery*; D006499:Hepatic Artery; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D013927:Thrombosis / Q000150:complications