A case of high flow biliary fistula after surgery

L. Assandri, I. Ghidotti

Research output: Contribution to journalArticlepeer-review


An 84-year-old male underwent distal splenopancreasectomy for a pancreatic cancer. After 12 days, hemoperitoneum starting from the pancreatic stump and necrotic ischemic cholecystitis occurred. Cholecystectomy and hemostasis were performed, and drainages were set up. Subse-quently, he presented fever and high flow (500 ml/day) biliary output from the retro-epiploic drainage. Endoscopic retrograde cholangiopancreatography (ERCP) was performed and colan-giogram showed a Bergman type B leak of the common bile duct. Despite sphincterotomy, with placement of single and multiple plastic stents, biliary output persisted. We suggested that surgeons retract drainage in order to favor biliary flow to the duodenum, however self-expandable metallic stent (SEMS) placement during a further ERCP was preferred, obtaining complete leak resolution. This case is emblematic of the difficulty of identifying patients who deserve SEMS “ab initio” in order to reduce multiple ERCPs, among the majority of patients who respond well to conventional endoscopic treatment. Moreover, multidisciplinary collaboration between col-leagues is essential for management of iatrogenic biliary lesions. © 2020, Area Qualita Srl. All rights reserved.
Original languageItalian
Pages (from-to)75-78
Number of pages4
JournalG. Ital. Endosc. Dig.
Issue number1
Publication statusPublished - 2020
Externally publishedYes

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