Treatment of Biliary Leakage by an Adjoined Antegrade and Retrograde Percutaneous Transhepatic Cholangio Drainage Approach: A Case Report

Introduction

In rare cases the treatment of central bile duct leaks is neither possible by joint endosopic and fluoroscopically guided PTCD maneuvers nor by open surgery. We report the successful interventional radiological repair of a defect in the hepatic bile duct bifurcation by means of a new adjoined antegrade and retrograde PTCD approach. The patient had liver metastasis and colon carcinoma treated by hemihepatectomy and secondary radiofrequency ablation. The resulting defect of the central bile ducts was not accessible by PTCD or surgery. Therefore, it was closed by introducing percutaneously a Yamakawa prosthesis using a fluoroscopically guided antegrade and retrograde pull-through technique via the distal common bile duct and the left hepatic bile duct. To the authors knowledge the pull-through-maneuver of a wire from the distal common bile duct to an intrahepatic bile duct using percutaneous approaches has not been described thus far in the literature.