A case of bilioduodenal fistula treated with a self-expandable metallic stent

We report the case of a 72 year-old female patient who suffered from biliar y fistulae. The biliobiliary and bilioduodenal fistulae appeared after an o peration for biliary bleeding. Conventional therapy for biliary fistula wou ld be the disconnection of the fistula by either conservative or operative treatment. In the present case, however, it was preferable to enlarge the f istula to drain bile juice into the duodenum, rather than to close the fist ula because it would have been difficult to achieve a tight adhesion with t his operation. The enlargement by a plastic tube stent failed to drain the bile juice into the duodenum, because the sludge made the tube stenotic. Th erefore, a self-expandable metallic stent was applied in this case. An expa ndable stent was used because a large final caliber is necessary to prevent stenosis of the fistula by sludge and mucosal hyperplasia. After insertion of a self-expandable metallic stent by the percutaneous transhepatic bilia ry drainage route, the patient has not suffered from cholestasis and cholan gitis or the last 30 months. It can therefore be concluded that enlargement of the fistula by a self-expandable metallic stent is a convenient; therap y for such biliointestinal fistulae.