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Biliary Leaks: Treatment by Means of Percutaneous Transhepatic Biliary Drainage¹

¹ From the Department of Radiology, Centre Hospitalier Universitaire de Lille, 1 place de Verdun, F-59037 Lille, France. Received March 25, 1998; revision requested June 19; final revision received September 16; accepted October 26. Address reprint requests to O.E.

PURPOSE: To evaluate the efficacy of percutaneous transhepatic biliary drainage in the treatment of biliary leaks.

MATERIALS AND METHODS: Sixteen patients with a biliary leak involving either the common bile duct (n = 12), the biliary confluence (n = 2), or a hepaticojejunal anastomosis (n = 2) were treated by means of percutaneous transhepatic biliary drainage. The biliary leak was due to severe acute necrotizing pancreatitis in six patients, while 10 patients had postoperative leak. Percutaneous transhepatic biliary drainage was performed with a 12-F catheter, with two series of side holes positioned on both sides of the extravasation to divert bile flow away from the defect.

RESULTS: In 13 patients, the biliary leak healed after drainage (mean duration, 78 days). In four of these patients, a slight residual narrowing of the bile duct was treated by means of either balloon dilation (n = 2) or balloon dilation followed by insertion of a metallic stent (n = 2). All 13 patients remained cured (mean follow-up, 38 months). Two patients with severe acute necrotizing pancreatitis died of complications unrelated to the biliary leak. Vascular complications occurred in two patients, one of whom died after surgical drainage of a subcapsular hematoma.

CONCLUSION: Biliary leaks can be treated successfully by means of percutaneous transhepatic biliary drainage. The procedure is particularly useful when surgical or endoscopic management has failed.

Index terms: Bile ducts, injuries, 76.284 • Bile ducts, interventional procedure, 76.1263, 76.1267 • Bile ducts, leakage, 76.1263, 76.284 • Pancreatitis, 77.291