Skip to main content
SpringerLink
Log in

Percutaneous Transhepatic Biliary Drainage and Occlusion Balloon in the Management of Duodenal Stump Fistula

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Duodenal stump fistula (DSF) after gastrectomy is a complication with a high mortality rate. We report a series of patients with postoperative DSF treated with percutaneous transhepatic biliary drainage and occlusion balloon (PTBD-OB). The aim of this study is to explore the feasibility and efficacy of PTBD-OB in the treatment of DSF.

Patients and Methods

Six patients developing DSF underwent PTBD-OB because of high DSF output and because medical and surgical management was unsuccessful. In these patients, an occlusion balloon was percutaneously inserted into the common bile duct and a biliary drain was positioned above the balloon to obtain external drainage of bile.

Results

In all cases, percutaneous access to the biliary tree was achieved. Patients maintained the PTBD-OB for a median of 43 days. In all patients, DSF output decreased after PTBD-OB placement from a median of 500 to 100 ml/day (p = 0.02). The DSF resolved in three patients and three patients died of sepsis, but in two of them, death was related to other digestive fistulas that developed before PTBD-OB placement.

Conclusions

This paper presents the first published series on DSF management with PTBD-OB and shows that it is a feasible and safe procedure which reduces DSF output.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Cozzaglio L, Coladonato M, Biffi R, Coniglio A, Corso V, Dionigi P, Gianotti L, Mazzaferro V, Morgagni P, Rosa F, Rosati R, Roviello F, Doci R. Duodenal fistula after elective gastrectomy for malignant disease. An Italian retrospective multicenter study. J Gastrointest Surg 2010;14:805–811.

    Article  PubMed  Google Scholar 

  2. Villar R, Fernandez R, Gonzales J, Oliver JO, Parga G, Garcia-Hidalgo E. High output external duodenal fistula: treatment with percutaneous transhepatic biliary/duodenal drainage. Cardiovasc Intervent Radiol 1996;19:371–373.

    Article  PubMed  CAS  Google Scholar 

  3. Zarzour JG, Christein JD, Drelichman ER, Oser RF, Hawn MT. Percutaneous transhepatic duodenal diversion for the management of duodenal fistulae. J Gastrointest Surg 2008;12:1103–1109.

    Article  PubMed  Google Scholar 

  4. Pedicini V, Poretti D, Mauri G, Trimboli M, Brambilla G, Sconfienza LM, Cornalba GP, Sardanelli F. Management of post-surgical biliary leakage with percutaneous transhepatic biliary drainage (PTBD) and occlusion balloon (OB) in patients without dilatation of the biliary tree: preliminary results. Eur Radiol 2010;20:1061–1068.

    Article  PubMed  Google Scholar 

  5. Funaki B, Zaleski GX, Straus CA, Leef JA, Funaki AN, Lorenz J, Farrell TA, Rosenblum JD. Percutaneous biliary drainage in patients with nondilated intrahepatic bile ducts. Am J Roentgenol 1999;173:1541–1544.

    CAS  Google Scholar 

  6. Cozzi G, Severini A, Civelli E, Milella M, Pulvirenti A, Salvetti M, Romito R, Suman L, Chiaraviglio F, Mazzafero V. Percutaneous transhepatic biliary drainage in the management of postsurgical biliary leaks in patients with nondilated intrahepatic bile ducts. Cardiovasc Intervent Radiol 2006;29:380–388.

    Article  PubMed  Google Scholar 

  7. Isik B, Yilmaz S, Kirimlioglu V, Sogutlu G, Yilmaz M, Katz D. A life-saving but inadequately discussed procedure: tube duodenostomy. Known and unknown aspects. World J Surg 2007;31:1616–1624.

    Google Scholar 

  8. Rossi JA, Sollenberger LL, Rege RV, Glenn J, Johel RJ. External duodenal fistulas. Arch Surg 1986;121:908–912.

    PubMed  CAS  Google Scholar 

  9. Burch JM, Cox CL, Feliciano DV, Richardson RJ, Martin RR. Management of the difficult duodenal stump. Am J Surg 1991;167:522–526.

    Article  Google Scholar 

Download references

Acknowledgments

We thank Emanuela Morenghi, MD, Department of Biostatistics, IRCCS Istituto Clinico Humanitas, Rozzano (MI) Italy, for her assistance in the statistical analysis, Mrs Marije de Jager and Mrs Rosalind Roberts for their editorial assistance, and Mr Andrea Compostella for his assistance with the figures.

Author information

Authors and Affiliations

  1. Division of Surgical Oncology, IRCCS Istituto Clinico Humanitas, Via Manzoni 56, 20089, Rozzano, MI, Italy

    Luca Cozzaglio, Matteo Cimino, Antonella Ardito & Roberto Doci

  2. University of Milan, Milan, Italy

    Giovanni Mauri

  3. Interventional Radiology Unit of the Department of Radiology, IRCCS Istituto Clinico Humanitas, Rozzano, MI, Italy

    Giovanni Mauri, Vittorio Pedicini, Dario Poretti & Giorgio Brambilla

  4. Division of General Surgery, University of Milan-IRCCS Istituto Clinico Humanitas, Rozzano, MI, Italy

    Matteo Sacchi

  5. Division of General and Minimally Invasive Surgery, IRCCS Istituto Clinico Humanitas, Rozzano, MI, Italy

    Alessandra Melis

Authors
  1. Luca Cozzaglio
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Matteo Cimino
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Giovanni Mauri
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Antonella Ardito
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Vittorio Pedicini
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Dario Poretti
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Giorgio Brambilla
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Matteo Sacchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Alessandra Melis
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Roberto Doci
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Luca Cozzaglio.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Cozzaglio, L., Cimino, M., Mauri, G. et al. Percutaneous Transhepatic Biliary Drainage and Occlusion Balloon in the Management of Duodenal Stump Fistula. J Gastrointest Surg 15, 1977–1981 (2011). https://doi.org/10.1007/s11605-011-1668-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-011-1668-6

Keywords

Search

Navigation