Combined endoscopic and percutaneous transhepatic approach in postsurgicalcommon bile duct occlusion

History and clinical findings: A 48-year-old patient was transferred to our hospital suffering from acute cholangitis due to complete bile duct occlus ion one year after a laparoscopic cholecystectomy. Main complaints were fev er over 40 degreesC and chills, accompanied by right upper quadrant abdomin al pain and jaundice. Investigations: Cholestastic enzymes, transaminases and leucocytes were inc reased. Transabdominal utrasound showed massive dilatation of the intrahepa tic bile ducts. ERCP was performed and revealed a complete and impassable o bstruction of the proximal common bile duct. Treatment and course: The bile duct occlusion following cholecystectomy was the reason for the patient's cholangitis. Neither via FRCP nor via the per cutaneous transhepatic approach was it possible to make a communication bet ween the proximal and the distal biliary system, none of the guidewires bei ng able to pass the obstruction. However, we finally managed to pass the ob struction in a combined endoscopic-percutaneous transhepatic rendez-vous te chnique. The patient received a percutaneous large-calibre plastic prosthes is (Yamakawa type). 4 months after the procedure the stenosis could hardly be detected. Conclusion: Endoscopic treatment is successful in most patients with post-c holecystectomy bile duct strictures. Therefore, repeated surgery is usually not necessary. Even in complete bile duct occlusions, the combined endosco pic-percutaneous transhepatic method can re-open the obstruction and is the refore a possible alternative to surgery in selected cases.