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Selective Trans-Catheter Coil Embolization of Cystic Duct Stump in Post-Cholecystectomy Bile Leak

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Abstract

Background

Percutaneous drainage is a first-line treatment for bilomas developed post-cholecystectomy in the setting of bile leak from the cystic duct stump. Percutaneous drainage is usually followed by surgical or endoscopic treatment to address the leak.

Aims

This study aimed to evaluate outcome of selective coil embolization of the cystic duct stump via the percutaneously placed drainage catheters in patients with post-cholecystectomy bile leak.

Methods

Seven patients with persistent bile leak after laparoscopic cholecystectomy who underwent percutaneous catheter placement for biloma/abscess formation in the region of the gallbladder fossa were followed. These patients underwent selective trans-catheter cystic duct stump coil embolization from Feb 2013 to Feb 2019. Procedural management, complications, and success rates were analyzed.

Results

All patients underwent placement of a percutaneous catheter for drainage of biloma formation in the gallbladder fossa post-cholecystectomy. Selective coil embolization of the cystic duct was performed through the existing percutaneous tract on average 3.5 weeks after percutaneous catheter placement, resulting in resolution of the biloma. All bile leaks were immediately closed. None of the patients showed recurrent bile leak or further clinical symptoms. Coil migration to the common bile duct was diagnosed in a single case, after 2.5 years, with no bile leak reported.

Conclusions

Selective trans-catheter coil embolization of the cystic stump is a feasible and safe procedure, which successfully seals leaking cystic duct stumps and can circumvent the need for repeat surgical or endoscopic intervention in selected patient populations.

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Authors and Affiliations

  1. Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA

    Nariman Nezami, Haddy Jarmakani, Melih Arici, Igor Latich, Hamid Mojibian, Rajasekhara R. Ayyagari, Jeffrey S. Pollak & Juan Carlos L. Perez Lozada

Authors
  1. Nariman Nezami
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  2. Haddy Jarmakani
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  3. Melih Arici
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  4. Igor Latich
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  5. Hamid Mojibian
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  6. Rajasekhara R. Ayyagari
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  7. Jeffrey S. Pollak
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  8. Juan Carlos L. Perez Lozada
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Contributions

NN assisted two clinical cases and involved in data collection, analysis, drafting the manuscript, and revision of the manuscript. HJ helped in collecting the data, writing the discussion section and editing/revising the manuscript. MA done two clinical cases. IL involved in one clinical case and revising the manuscript. HM done one clinical case. RRA involved in one clinical case. JSP involved in conceptualized, supervision, and revision of the manuscript. JCPL done two clinical cases, involved in conceptualization, supervision, methodology, and revision of the manuscript.

Corresponding author

Correspondence to Juan Carlos L. Perez Lozada.

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The authors declare no conflicts of interest.

Ethical approval

This was a retrospective study with IRB approval from Yale University School of Medicine (IRB ID: 2000023935).

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Cite this article

Nezami, N., Jarmakani, H., Arici, M. et al. Selective Trans-Catheter Coil Embolization of Cystic Duct Stump in Post-Cholecystectomy Bile Leak. Dig Dis Sci 64, 3314–3320 (2019). https://doi.org/10.1007/s10620-019-05677-5

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  • DOI: https://doi.org/10.1007/s10620-019-05677-5

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