P1804 - Creation of a Neo-Bile Duct in a Patient With Left Hepatic Duct Clipping and Right Hepatectomy

Rahil Desai, DO¹, Ahamed Khalyfa, DO², Navkiran Randhawa, DO³, Varshita Goduguchinta, DO⁴, Mahnoor Inamullah, MD⁵, Kamran Ayub, MD^6
1Franciscan Health Olympia Fields, Westlake, OH; ²University of Iowa, Iowa City, IA; ³Augusta University, Medical College of Georgia, Dyer, IN; ⁴Franciscan Health Olympia Fields, Chicago, IL; ⁵Southwest Gastroenterology, a Division of GI Partners of Illinois, Oak Lawn, IL; ⁶Silver Cross Hospital, New Lenox, IL

Introduction: Colorectal cancer is the third most common cancer in the US, and if not detected early, can have metastasis to the liver. Many patients undergo hepatic lobe resection for solitary metastasis. This surgery can result in Iatrogenic bile duct injuries (IBDI). We present a video case of a patient with IBDI after a right hepatectomy who was successfully treated with hepaticoduodenostomy.

Case Description/Methods:

A 64 year-old female with a past medical history of sigmoid colon cancer s/p bowel resection  with solitary metastasis to the right lobe of the liver presents with jaundice and early satiety. The patient underwent right hepatectomy, and unfortunately during surgery, the left hepatic duct was clipped and transected. Attempts at an ERCP were unsuccessful, and the patient was referred for percutaneous transhepatic biliary drain (PTBD). The hepatic ducts were completely collapsed and placement of a PTBD was unsuccessful despite numerous attempts. It was decided to attempt an EUS guided hepaticoduodenostomy. The left hepatic duct was punctured near the hilum using a 19G needle and a guidewire was passed. The tract was dilated using 7F Soehendra dilator, followed by balloon dilation to 4mm. An (8mm x 8cm) Viabil Stent was placed with excellent drainage. The patient's JP drain output dropped from 400cc per day to 25cc in the first 24 hours. The drain was eventually removed in one week, and the patient has continued to do well with the newly created hepaticoduodenostomy. 

Discussion:

IBDI during surgery can have severe complications, often requiring liver transplantation or hepaticojejunostomy. Our video presentation demonstrates EUS guided hepaticoduodenostomy when ERCP and PTBD are unsuccessful at obtaining access to a collapsed biliary system.

Disclosures:


Rahil Desai, DO¹, Ahamed Khalyfa, DO², Navkiran Randhawa, DO³, Varshita Goduguchinta, DO⁴, Mahnoor Inamullah, MD⁵, Kamran Ayub, MD⁶. P1804 - Creation of a Neo-Bile Duct in a Patient With Left Hepatic Duct Clipping and Right Hepatectomy, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.