PERCUTANEOUS MICROCOIL EMBOLIZATION OF INTRAPERITONEAL INTRAHEPATIC AND EXTRAHEPATIC BILIARY FISTULAS

Background: Persistent intraperitoneal biliary fistulas are associated with significant morbidity and mortality. Percutaneous drainage, sten ting, and endoscopic sphincterotomy or embolization of biliary radical s have largely replaced the need for hepatic resection or biliary reco nstruction in managing such fistulas. When endoscopy is contraindicate d, a previously undescribed technique of percutaneous embolization of intrahepatic and extrahepatic biliary fistula following penetrating li ver trauma, and orthotopic liver transplant and its application in thr ee patients, will be discussed. Methods: Embolization procedures were performed by an interventional radiologist. Percutaneous trans-hepatic cholangiography via a standard right-side approach or via tube cholan giography was initially performed and the fistula defined. Coaxial cat heter systems were used (5 Fr angiography catheters and Tracker 18 inf usion catheters), and were positioned within the biliary tree as close as possible to the origin of the fistula. Embolization was performed using vascular Embolization 28 coils (WA Cook) 2-3 mm x 2 cm coils, st raight Hilal 18 embolization coils (WA Cook) 5-7 cm, as well as Gelfoa m (Upjohn) 1 mm pellets, and Histoacryl (B. Braun) 0.25-1 mt. Occlusio n of the duct was confirmed by a selective intrahepatic cholangiogram. In cases of multiple fistulas several embolizations were performed at subsequent procedures. Follow-up is over 13 months without adverse ev ent. Results: The technique was used in the three cases and was succes sful in all. A peripheral biliary fistula required embolization twice and two cystic leaks were cured after a single attempt. Conclusions: P ercutaneous embolization of biliary fistulas provides a management opt ion in cases where conservative treatment has failed and other techniq ues are relatively contraindicated. The technique is effective and saf e in skilled hands, and avoids major surgery. The long-term effect of microcoils in the biliary tree is unknown.