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Digestive Diseases and Sciences

, Volume 59, Issue 5, pp 1063–1065 | Cite as

Intraoperative Identification of Bile Duct Perforation Following ERCP Using Indocyanine Green-Fluorescence Imaging

  • Yoshikuni Kawaguchi
  • Takeaki Ishizawa
  • Yuzo Harada
  • Motoki Nagai
  • Yukihiro Nomura
  • Sachio Hata
  • Kenji Shimura
  • Norihiro KokudoEmail author
  • Nobutaka Tanaka
Case Report

Introduction

Perforation related to endoscopic retrograde cholangiopancreatography (ERCP) is a rare but serious complication, occurring at an incidence ranging from 0.35 to 2.1 % [1, 2, 3]. Surgical treatment is sometimes needed to close the bile leak if patients fail conservative treatments by biliary drainage and antibiotics. However, it is usually difficult to detect small perforating injury on the bile duct during surgery, which may lead to insufficient closure of the bile leak or unnecessary biliary reconstruction. Here, we report a case of surgical management of a bile leak following ERCP using indocyanine green (ICG)-fluorescence imaging which allowed detection of a small hole in the common bile duct.

Case Report

An 89-year-old female who had undergone cholecystectomy for gallstones presented with choledocholithiasis. ERCP revealed multiple stones in the common bile duct (CBD), and during removal of the stones with basket-type forceps, extravasation of the contrast material from...

Keywords

Fluorescence imaging technique Indocyanine green Bile duct perforation Endoscopic retrograde cholangiopancreatography 

Abbreviations

ERCP

Endoscopic retrograde cholangiopancreatography

ICG

Indocyanine green

CBD

Common bile duct

ENBD

Endoscopic nasobiliary drainage

Notes

Conflict of interest

None.

Supplementary material

Supplementary Video 1. Following laparotomy, the CBD and the duodenum were identified. Fluorescence cholangiography performed by injecting ICG through the ENBD tube delineated the leakage of bile, allowing precise identification of the point of perforation. No bile leak was observed after closure of the perforation. (MPG 24,116 kb)

References

  1. 1.
    Cotton PB, Lehman G, Vennes J, et al. Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc. 1991;37:383–393.PubMedCrossRefGoogle Scholar
  2. 2.
    Freeman ML, Nelson DB, Sherman S, et al. Complications of endoscopic biliary sphincterotomy. N Engl J Med. 1996;335:909–918.PubMedCrossRefGoogle Scholar
  3. 3.
    Enns R, Eloubeidi MA, Mergener K, et al. ERCP-related perforations: risk factors and management. Endoscopy. 2002;34:293–298.PubMedCrossRefGoogle Scholar
  4. 4.
    Ishizawa T, Tamura S, Masuda K, et al. Intraoperative fluorescent cholangiography using indocyanine green: a biliary road map for safe surgery. J Am Coll Surg. 2009;208:e1–e4.PubMedCrossRefGoogle Scholar
  5. 5.
    Kawaguchi Y, Ishizawa T, Masuda K, et al. Hepatobiliary surgery guided by a novel fluorescent imaging technique for visualizing hepatic arteries, bile ducts, and liver cancers on color images. J Am Coll Surg. 2011;212:e33–e39.PubMedCrossRefGoogle Scholar
  6. 6.
    Landsman ML, Kwant G, Mook GA, et al. Light-absorbing properties, stability, and spectral stabilization of indocyanine green. J Appl Physiol. 1976;40:575–583.PubMedGoogle Scholar
  7. 7.
    Verbeek FP, van der Vorst JR, Schaafsma BE, et al. Image-guided hepatopancreatobiliary surgery using near-infrared fluorescent light. J Hepatobiliary Pancreat Sci. 2012;19:626–637.PubMedCentralPubMedCrossRefGoogle Scholar
  8. 8.
    Ishizawa T, Fukushima N, Shibahara J, et al. Real-time identification of liver cancers by using indocyanine green fluorescent imaging. Cancer. 2009;115:2491–2504.PubMedCrossRefGoogle Scholar
  9. 9.
    Kaibori M, Ishizaki M, Matsui K, et al. Intraoperative indocyanine green fluorescent imaging for prevention of bile leakage after hepatic resection. Surgery. 2011;150:91–98.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Yoshikuni Kawaguchi
    • 1
    • 2
  • Takeaki Ishizawa
    • 1
  • Yuzo Harada
    • 2
  • Motoki Nagai
    • 2
  • Yukihiro Nomura
    • 2
  • Sachio Hata
    • 3
  • Kenji Shimura
    • 3
  • Norihiro Kokudo
    • 1
    Email author
  • Nobutaka Tanaka
    • 2
  1. 1.Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of MedicineUniversity of TokyoTokyoJapan
  2. 2.Department of SurgeryAsahi General HospitalChibaJapan
  3. 3.Department of GastroenterologyAsahi General HospitalChibaJapan

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