Creation of a fistula between the hepatic duct and the gastric lumen by way of percutaneus transhepatic cholangiography: a case report.
BACKGROUND
Cholangiocellular carcinoma accounts for 3% of gastrointestinal tumors. It is the second most common primary hepatic malignancy and is associated with primary sclerosing cholangitis.


METHODS
We report a patient with primary sclerosing cholangitis and cholangiocellular carcinoma who underwent partial hepatectomy and postoperatively suffered life-threatening biliary stasis with cholascos and peritonitis. The patient had cholangiocellular carcinoma recurrence at the resection margins and local lymph node metastases, but chemotherapy was not possible because of elevated bilirubin and liver dysfunction. After successful percutaneous stenting and placement of an internal-external drainage tube from the biliary tree to the gastric ventricle, ascites and cholascos resolved completely and the patient was then referred for chemotherapy. The internal-external drainage tube was converted to an internal tube after 3 1/2 months. The patient received chemotherapy and survived 14 months after stenting.


CONCLUSIONS
Preferably, bile leaks should be detected preoperatively but the ongoing development of solutions to the postoperative biliary complications seen in these patients is extremely important.
Lauridsen
Mette Enok Munk
ME
Medical Department V, Aarhus University Hospital, Noerrebrogade 44, DK-8000, Aarhus C, Denmark. mettelauridsen@gmail.com
Mortensen
Frank V
FV
Nielsen
Dennis T
DT
Grønbæk
Henning
H
D000328:Adult; D001650:Bile Duct Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic / Q000473:pathology / Q000601:surgery*; D018281:Cholangiocarcinoma / Q000150:complications / Q000473:pathology / Q000601:surgery*; D002758:Cholangiography / Q000379:methods*; D015209:Cholangitis, Sclerosing / Q000150:complications / Q000473:pathology / Q000601:surgery; D002779:Cholestasis / Q000601:surgery; D004322:Drainage / Q000379:methods*; D006498:Hepatectomy; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D011183:Postoperative Complications / Q000473:pathology / Q000601:surgery*; D013270:Stomach / Q000601:surgery