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Review
. 2022 Nov 17;39(4):435-440.
doi: 10.1055/s-0042-1757343. eCollection 2022 Aug.

Stepwise Percutaneous Approach to Treat Severe Benign Hepaticojejunostomy Stenosis

Bashar Nahab  1 , Aakanksha Sriwastwa  1 , Charles Shelton  1 , Charles Ray  2 , Abouelmagd Makramalla  1 , Chadalavada Seetharam  1 , Ali Kord  1
Affiliations
Review

Stepwise Percutaneous Approach to Treat Severe Benign Hepaticojejunostomy Stenosis

Bashar Nahab et al. Semin Intervent Radiol. .
No abstract available

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Conflict of interest statement

Conflict of Interest The authors would like to state that they do not have any conflict of interest.

Figures

Fig. 1
Fig. 1
High T2 intense MRCP image ( a ) showing the dilated biliary tree with intrahepatic biliary dilatation. Complete obstruction is visualized at the hepaticojejunostomy anastomosis (solid arrow). A coronal single-shot fast spin echo sequence (SSFSE) MRI image ( b ) delineates the close proximity of the obstructed duct (solid arrow) to the small bowel (dotted arrow).
Fig. 2
Fig. 2
Algorithm summarizing a stepwise approach to treat patients with severe benign hepaticojejunostomy stenosis.
Fig. 3
Fig. 3
A 27-year-old woman presented with signs and symptoms of cholangitis. Endoscopic approach failed due to complete obstruction. PTC from left hepatic duct approach ( a ) shows total obstruction of the hepaticojejunostomy anastomosis (solid arrow). An external biliary drain was placed ( b , dotted arrow). No further manipulation at the time of drain placement was attempted in order to decrease the chance of bacteremia.
Fig. 4
Fig. 4
A 37-year-old woman status post liver transplant with worsening abdominal pain. A delayed contrast-enhanced MRI using Eovist ( a ) demonstrates contrast extravasation (dotted arrows) at the hepaticojejunostomy anastomosis (solid arrow) which appears stenotic. Needle cholangiogram from a left-side approach shows appropriate position of the needle in a peripheral bile duct ( b ). Minimal enhancement of left portal vein is seen ( a , asterisk) from the access attempts. A microwire advanced into the bile duct ( c , arrow), followed by serial dilation and a biliary drain placement ( d , solid arrow). Biliary leak ( d , dotted arrows) is more evident on the final cholangiogram.
Fig. 5
Fig. 5
Same patient in Fig. 3 returned for percutaneous biliary recanalization. A percutaneous cholangioscope used to identify the stenotic lumen ( a , arrow). Initial attempts of recanalization were not successful. A percutaneous access ( b , arrow) was obtained into the adjacent small bowel and contrast injected to stain the bowel ( b , asterisk). The anastomosis was successfully crossed, and contrast injection confirmed positioning in the small bowel ( c , dotted arrow). Extraluminal contrast was visualized under the liver edge ( c , arrowheads). An external–internal biliary drain was placed ( d , arrows) after cholangioplasty of the anastomotic stricture.
Fig. 6
Fig. 6
Percutaneous cholangioscope images showing severe stenosis of the hepaticojejunostomy anastomosis with white fibrous tissue (asterisk). Laser fiber was positioned in the field of view (arrow). A second safety wire is visualized at the periphery (arrowhead) passing the anastomosis to maintain the access.
See this image and copyright information in PMC

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