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At least 37 records · Page 2Linked to original sources
PubMed2006

Endoscopic stenting for selected cases of biliary fistula after hepatic hydatid surgery.

BACKGROUND: Biliary fistula develops in 4%-28% of patients after hepatic hydatid disease (HHD) surgery. Although endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (ES) are helpful in the treatment of this complication, persistent fistulas may occur. We therefore conducted a study to evaluate the efficacy of endoscopic biliary stenting in the treatment of biliary fistulas after HHD. METHODS: In this study, 84 patients who underwent ERCP for postoperative biliary fistula due to HHD were evaluated. Group I included 70 patients treated with only ES, and group II included 14 patients who underwent biliary stenting as their initial treatment. Demographic data, complications, the results of treatment and the reasons for the failure were compared between two groups. RESULTS: Ninety-five ERCPs were performed. In 63 patients, biliary fistulas were successfully treated with only ERCP and ES. However, 7 patients underwent repeat ERCP and stent placement because of persistent fistula. Biliary stenting was initially performed in 14 patients. The average time for closure of the fistula was 14 +/- 10 days and 7 +/- 3 days in group I (7 patients with repeat ERCP were excluded) and group II, respectively (p = 0.007). There was no statistically significant difference in the complication rates between the groups. CONCLUSIONS: Although ES is effective in the treatment of biliary fistula after HHD surgery, endoscopic biliary stenting may be considered as the initial procedure in patients with biliary stricture, incomplete clearance of hydatid material in the bile duct, and persisting biliary fistulas after treatment with ERCP and ES.

Adolescent↗
PubMed1989

[Percutaneous drainage of fistula-associated abscesses and biliary fistulas].

33 abdominal abscesses associated with fistulae in 31 patients were treated by percutaneous drainage. 19 of these patients had had surgery immediately preceding the drainage. In 64% the percutaneous drainage led to a diagnosis of an internal fistula. Additional therapeutic measures, because of the fistula, were necessary in 45% (operation, biliary drainage, repositioning of catheter). The average duration of drainage was 29 days. 77% of those abscesses which could be drained were treated successfully. Mortality in the entire series was 19%.

Abdomen↗
PubMed1997

Percutaneous microcoil embolization of intraperitoneal intrahepatic and extrahepatic biliary fistulas.

BACKGROUND: Persistent intraperitoneal biliary fistulas are associated with significant morbidity and mortality. Percutaneous drainage, stenting, and endoscopic sphincterotomy or embolization of biliary radicals have largely replaced the need for hepatic resection or biliary reconstruction in managing such fistulas. When endoscopy is contraindicated, a previously undescribed technique of percutaneous embolization of intrahepatic and extrahepatic biliary fistula following penetrating liver trauma, and orthotopic liver transplant and its application in three patients, will be discussed. METHODS: Embolization procedures were performed by an interventional radiologist. Percutaneous trans-hepatic cholangiography via a standard right-side approach or via tube cholangiography was initially performed and the fistula defined. Coaxial catheter systems were used (5 Fr angiography catheters and Tracker 18 infusion catheters), and were positioned within the biliary tree as close as possible to the origin of the fistula. Embolization was performed using vascular Embolization 28 coils (WA Cook) 2-3 mm x 2 cm coils, straight Hilal 18 embolization coils (WA Cook) 5-7 cm, as well as Gelfoam (Upjohn) 1 mm pellets, and Histoacryl (B. Braun) 0.25-1 mL. Occlusion of the duct was confirmed by a selective intrahepatic cholangiogram. In cases of multiple fistulas several embolizations were performed at subsequent procedures. Follow-up is over 13 months without adverse event. RESULTS: The technique was used in the three cases and was successful in all. A peripheral biliary fistula required embolization twice and two cystic leaks were cured after a single attempt. CONCLUSIONS: Percutaneous embolization of biliary fistulas provides a management option in cases where conservative treatment has failed and other techniques are relatively contraindicated. The technique is effective and safe in skilled hands, and avoids major surgery. The long-term effect of microcoils in the biliary tree is unknown.

Adult↗
PubMed1987

Hypercholeresis induced by norchenodeoxycholate in biliary fistula rodent.

The biliary recovery and effect on bile flow and biliary bicarbonate secretion of infused norchenodeoxycholate (nor-CDC), the synthetically prepared C23 homologue of chenodeoxycholate (CDC), were defined in the anesthetized biliary fistula hamster, rat, and guinea pig and compared with those of its taurine conjugate as well as those of the natural C24 bile acid, CDC. In the hamster and rat, nor-CDC was recovered slowly in bile in contrast to its taurine conjugate or CDC. Hepatic biotransformation of nor-CDC was complex. Little amidation with glycine or taurine occurred and the compound was recovered in bile in unchanged form, in the form of hydroxylated derivatives as well as glucuronates and sulfates, the proportion varying in the different species. In contrast, CDC was efficiently amidated with glycine or taurine. The taurine conjugate of nor-CDC was secreted largely unchanged. Nor-CDC infusion caused a striking hypercholeresis in the hamster (108 microliters bile/mumol bile acid in bile) and in the rat (220 microliters/mumol); these values for bile acid-dependent flow far exceed those reported for any other natural bile acid to date in these species. The induced hypercholeresis was of canalicular origin and was accompanied by an enrichment in bicarbonate ion concentration as well as increased bicarbonate output. The taurine conjugate of nor-CDC did not display hypercholeretic properties in the hamster. In the guinea pig, whose native bile is bicarbonate-rich relative to other species, nor-CDC was only mildly hypercholeretic relative to CDC and caused no change in bicarbonate concentration. Thus shortening the side chain of a natural dihydroxy bile acid by a single carbon atom formed a compound that underwent a different hepatic biotransformation than that of most natural bile acids and induced a bicarbonate-rich canalicular choleresis far greater than that which can be explained by current theories of bile formation.

Animals↗
PubMedDate not supplied

Utility of stent-grafts in treatment of porto-biliary fistula.

A porto-biliary fistula causing hemobilia is a known complication of percutaneous transhepatic biliary drainage (PTBD). We present two patients with hemobilia secondary to porto-biliary fistula, treated successfully by percutaneous placement of stent-grafts. In one case, the stent-graft was placed in the bile duct, and in the other case, it was placed in the intrahepatic portal vein branch. Hemobilia stopped and there were no complications except a small area of hepatic infarction, distal to the stent-graft in the portal vein.

Arterial Occlusive Diseases↗
PubMed1996

Radiological findings in biliary fistula and gallstone ileus.

PURPOSE: Biliary fistula and gallstone ileus are rarely found. The diagnosis is difficult and may be delayed until operation. We reviewed the radiological findings in a retrospective material. MATERIAL AND METHODS: The cases of 16 patients treated for biliary fistula were analyzed with respect to findings at imaging. Ten patients had a spontaneous fistula. Nine of them had an internal bilioduodenal fistula and one had an external fistula with stones passing through a subcutaneous abscess. Five patients also had gallstone ileus and one patient a rare gastric outlet obstruction caused by a gallstone (Bouveret's syndrome). Six patients had an iatrogenic fistula. One of them had internal bile ascites and 5 an external fistula, one of which was a biliocystic fistula resulting from attempted hepatic cyst sclerotherapy. RESULTS: Various imaging modalities were used and there was often a delay in the diagnosis. Imaging did not show the fistula itself in any of the spontaneous cases. However, a nonvisualized or shrunken gallbladder seen at US often coexisted in these cases. CT yielded the diagnosis in one case of gallstone ileus, and a Gastrografin meal yielded it in the case of Bouveret's syndrome. Fistulography and cholangiography provided a correct diagnosis of fistula in all cases of iatrogenic biliocutaneous fistulas. CONCLUSION: Patients with biliary fistula usually undergo examinations with nonspecific results. The imaging findings could be more specific if the possibility of this diagnosis were remembered.

Aged↗
PubMedDate not supplied

Successful treatment of postoperative external biliary fistulas by endoscopic sphincterotomy.

External biliary fistulas occur as a complication of biliary tract surgery. Until recently, excision of the fistula was the primary therapeutic modality. We describe seven cases of postoperative external biliary fistula successfully treated by endoscopic papillotomy. Fistulation occurred in four patients after operations for hydatid cysts of the liver, in one patient after cholecystectomy for acute cholecystitis, in one patient with carcinoma of the periampullary region after a decompression procedure, and in the remaining patient after an intraoperative biopsy of a carcinoma of the gallbladder. Endoscopic sphincterotomy is a reliable and effective therapeutic alternative in patients with external biliary fistulas.

Biliary Fistula↗
PubMed1991

Spontaneous external biliary fistula uncomplicated by gallstones.

External biliary fistulae are rare. Only 65 cases have been reported in the literature and in each instance gallstones were a complicating factor. We report in this paper the first case of spontaneous external (cholecystocutaneous) biliary fistula uncomplicated by gallstones.

Aged↗
PubMed1994

Modern concepts in nonsurgical management of traumatic biliary fistulas.

The management of traumatic biliary fistulas is controversial. New ideas in nonsurgical treatment have recently evolved, in part because of the rapid advancement of laporoscopic surgery. Three major concepts are important in managing biliary fistulas: diagnosis, drainage, and decompression. These concepts were applied to a trauma patient, then reviewed in detail.

Adult↗
PubMedDate not supplied

[Endoscopic management of biliary fistula].

OBJECTIVE: To assess safety and efficacy of endoscopic therapy for patients with a postoperative biliary fistula. BACKGROUND: Biliary fistula that occur after operations on the biliary tract may be due to bile duct injury or distal bile duct obstruction. These fistulas has been managed with surgical correction. At present, endoscopic methods of improving biliary drainage has been found to be highly successful in the management of postsurgical biliary leaks. PATIENTS-METHODS-RESULTS: By endoscopic cholangiopancreatography (ERCP) we diagnosed 35 patients (23 females and 12 males) with postoperative biliary fistula. Four patients had history of laparoscopic cholecystectomy. We used endoscopic sphincterotomy (18 cases) or endoprosthesis placement (17 cases) in the treatment. Seventeen patients with fistula plus common bile duct (CBD) stones and one patient with benign papillary stenosis were treated with endoscopic sphincterotomy alone. Seventeen patients without CBD stones were treated with only endoprosthesis placement. A second ERCP confirmed healing of the leakage after 4-16 weeks. CONCLUSIONS: Postoperative bile leakage could be diagnosed safely and effectively by ERCP, subsequent endoscopic management in most cases is successful. Sphincterotomy alone is the preferred treatment for biliary fistula-complicating surgery for gallstone disease. Alternatively, when a fistula is large, endoscopic placement of an endoprosthesis can be proposed as the first treatment.

Adolescent↗
PubMed1984

The role of HIDA scanning in the assessment of external biliary fistulae.

Three patients with postoperative external biliary fistula are described. In each, radionuclide 99Tcm HIDA was used to define the anatomy of the fistula. The extent of the fistula and the presence of distal obstruction to bile flow could also be determined. This information was used to predict the likelihood of spontaneous fistula closure. HIDA scanning is a useful noninvasive alternative to other investigations, such as fistulography and cholangiography, which do not always provide useful information. The results of HIDA scanning can aid the clinical decision on the need for surgical intervention to correct an external biliary fistula.

Adult↗
PubMed1990

Endoscopic management of biliary fistulas with small caliber stents.

Biliary fistulas have in the past been managed by a variety of methods, including surgical correction or endoscopic sphincterotomy. From 1984 to 1989, we used endoscopic indwelling biliary stents in seven consecutive patients with and without sphincterotomy and have attained fistula closure in all patients studied. The etiologies of the fistulous tracts varied, as did the type and number of stents used. The duration of time between stent placement and observed closure of the fistulous tracts ranged from 3 days to 5 months. Of note, all patients had a dramatic reduction of drainage within the first week. From our study we conclude that surgical correction of biliary fistulas is not required, that sphincterotomy is not mandatory for stent placement or fistula management in patients without distal obstruction, and that a single, small caliber stent alone may be effective.

Biliary Fistula↗
PubMedDate not supplied

Percutaneous interventional therapy of persistent biliary fistulas.

BACKGROUND: Persistent biliary leakage is a challenging problem when conservative treatment methods fail. We present our experience with alternative percutaneous radiologic interventions to seal refractory biliary leaks. METHODS: From April 1998 to December 2005, a retrospective analysis of 23 patients with biliary leakage revealed six patients who were unresponsive to drainage were treated with use of Histoacryl (n = 5), microcoils (n = 2), or covered stent (n = 2) alone or in various combinations. RESULTS: In all patients, the biliary leakage ceased following a single procedure. Distally migration of microcoils into the abscess cavity was observed in a one coiling procedure, which was clinically insignificant. In one patient treated with covered stent, in-stent restenosis was seen in the postprocedural second year, which required another intervention. No recurrence of fistula was noted in the follow-up period (ranging from 6 to 47 months). CONCLUSIONS: Persistent biliary fistulas can be treated successfully by means of various percutaneous radiological interventions that can decrease the morbidity associated with prolonged external drainage and avert the need for surgery. We recommend superselective embolization, preferably with Histoacryl, for a safe and effective control of leakage. Although restenosis after stenting remains problematic, covered stents should be reserved as a feasible alternative for selected cases.

Adult↗
PubMed2006

[Analysis on the anatomic features of 47 cases of hepatic hydatidosis complicated with biliary fistula].

OBJECTIVE: To propose a criterion and its significance of clinical classification of hepatic hydatidosis complicated with biliary fistula. METHODS: 47 hepatic hydatidosis with biliary fistula cases who were given a subadventitial pericystectomy were observed from 2000 to 2005 in a retrospective study. The methods included observation of the different anatomic features of hepatic hydatidosis complicated with biliary fistula during the surgical operation and evaluation of the curative effect. RESULTS: All the 47 patients recuperated successfully and had no complication. Based on the anatomic features of hepatic hydatidosis complicated with biliary fistula, a criterion on clinical classification was proposed as three types: tangential, transfixional and terminal types. CONCLUSIONS: Hepatic hydatidosis complicated with biliary fistula can be classified as three types according to its anatomic features.

Adult↗