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ACG Case Rep J. 2017; 4: e2.
Published online 2017 January 4. doi:  10.14309/crj.2017.2
PMCID: PMC5244888

Management of an Accessory Bile Duct Leak Following Pancreaticoduodenectomy: A Novel Approach Utilizing a Percutaneous and Endoscopic Rendezvous

George A. Rapp, MD,corresponding author1 Kari J. Nelson, MD,1 David K. Imagawa, MD, PhD, FACS,2 Jason Y. Huang, MD,3 and John G. Lee, MD3


Biliary leaks are uncommon but morbid complications of pancreaticoduodenectomies, which have historically been managed with percutaneous drainage, reoperation, or a combination of both. We report a de novo percutaneous-endoscopic hepaticojejunostomy from an anomalous right hepatic duct injured during pancreaticoduodenectomy to the afferent bowel limb. The percutaneous-endoscopic hepaticojejunostomy was stented to allow for tract formation with successful stent removal after 5.5 months. One year after the creation of the percutaneous-endoscopic hepaticojejunostomy, the patient remains clinically well without evidence of biliary leak or obstruction.

Articles from ACG Case Reports Journal are provided here courtesy of American College of Gastroenterology