胆管内無水エタノール注入（ｂｉｌｉａｒｙ　ａｂｌａｔｉｏｎ）により治癒した腹腔鏡下胆嚢摘出術後難治性胆汁瘻の１例

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  • A Case of Major Bile Leak after Laparoscopic Cholecystectomy Successfully Treated by Biliary Ablation with Absolute Ethanol

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A 75-year-old woman undergoing laparoscopic cholecystectomy for cholelithiasis developed a sudden high fever on postoperative day (POD) 4. Abdominal computed tomography (CT) showed intraabdominal fluid collection due to bile leakage, which was drained immediately with a 10Fr drainage tube. Fistulography showed leakage from the anterior segmental bile duct occluded by the hemostasis clip. We attempted percutaneous biliary ablation with absolute ethanol for the biliary fistula. A 5Fr balloon catheter was inserted through the fistula into the anterior segmental bile duct. After the balloon was inflated, contrast material was infused to determine the optimal dose of ethanol, then 2.5mL of absolute ethanol was infused and washed out after 5 minutes. We repeated this 3 or 4 times a day. During each procedure, the patient reported pain and flushing, then serum transaminase and serum alkaline phosphatase rose after the procedure. After 4 sessions of biliary ablation over 12 days, biliary drainage was eliminated. Abdominal CT showed no liver abscess. The drainage tube was removed 19 days after the first biliary ablation with no serious complications. One year after biliary ablation, the patient is doing well without signs of cholangitis or bile leakage. Biliary ablation is thus a safe, effective intervention for treating major bile leakage, especially in biliary fistulas that do not communicate with the remainder of the biliary tree.

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