title: Postoperative bile leakage managed by interventional intrabiliary ethanol ablation.
abstract: We report a case of postoperative bile leakage that was successfully managed by intrabiliary ethanol ablation. A 68-year-old man with peritoneal and liver metastases from a jejunal gastrointestinal stromal tumor (GIST), which were refractory to molecular-targeted agents, underwent extended left lobectomy and peritoneal tumor resection. Bile leakage from the drainage tube persisted at a constant volume of 100 ml per day. On the 20th postoperative day, fistulography through a drainage tube and endoscopic cholangiography revealed biliary leakage from the bile ducts of segments 5 and 1. Since these bile ducts did not communicate with the proximal hilar bile ducts, two 5F balloon catheters were separately advanced into the leaking bile ducts via the drainage tube on day 30, and 1 ml absolute ethanol was injected into both of these catheters for 10 minutes. After three sessions of ethanol ablation, the bile leakage stopped. Although the bile leakage from segment 1 relapsed five days later, it gradually decreased and then stopped again until day 70. Intrabiliary ethanol ablation using the interventional technique is useful for managing bile leakage after hepatectomy when the leaking distal bile duct is isolated from the proximal biliary tree.
authors.affiliation: Second Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu 431-3192, Japan. saka1119@hama-med.ac.jp
authors.forename: Takanori
authors.initials: T
authors.lastname: Sakaguchi
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Shibasaki
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Morita
authors.forename: Kosuke
authors.initials: K
authors.lastname: Oishi
authors.forename: Atsushi
authors.initials: A
authors.lastname: Suzuki
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Fukumoto
authors.forename: Keisuke
authors.initials: K
authors.lastname: Inaba
authors.forename: Manabu
authors.initials: M
authors.lastname: Ota
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Miyazaki
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Takehara
authors.forename: Shuhei
authors.initials: S
authors.lastname: Yamashita
authors.forename: Mika
authors.initials: M
authors.lastname: Kamiya
authors.forename: Takasuke
authors.initials: T
authors.lastname: Ushio
authors.forename: Kinya
authors.initials: K
authors.lastname: Kawamura
authors.forename: Shohachi
authors.initials: S
authors.lastname: Suzuki
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Konno
mesh_terms: D000368:Aged; D001646:Bile / Q000378:metabolism*; D001660:Biliary Tract Diseases / Q000000981:diagnostic imaging / Q000628:therapy*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D000431:Ethanol / Q000627:therapeutic use*; D046152:Gastrointestinal Stromal Tumors / Q000473:pathology*; D006498:Hepatectomy / Q000379:methods; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary* / Q000628:therapy*; D008297:Male; D049268:Positron-Emission Tomography; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000628:therapy*; D015911:Sclerotherapy / Q000379:methods; D012997:Solvents / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed
chemical_list: D012997:Solvents; D000431:Ethanol