Rendezvous Technique for the Treatment of Complete Common Bile Duct Transection After Multiple Hepatobiliary Surgeries

Abstract

Common bile duct (CBD) injury during surgical procedures is a serious complication. Partial injury can usually be managed by a combination of percutaneous and/or endoscopic techniques. However, the management of complete transection of the CBD is very challenging. There are small case series of nonsurgical management of complete CBD transection during laparoscopic cholecystectomy. In this particular case, a 55-year-old female patient had multiple operations because of malignant pheochromocytoma with liver metastases. She developed a complete CBD transection during right hepatectomy. A biloma was managed with image-guided percutaneous drainage. However, both attempts of percutaneous transhepatic cholangiography (PTC) and endoscopic retrograde cholangiopancreatography (ERCP) for CBD stent were unsuccessful, as the native CBD was partially resected during the injury. A rendezvous procedure, in which a guidewire was placed through the distal CBD and into a biloma by ERCP and subsequently snared with PTC, allowed for a biliary-duodenal catheter to be placed successfully and achieve continuity of the patient's biliary tree.