Rare case of removal of intrabiliary retained broken PTBD wire with redo-hepaticojejunostomy

Authors

  • Monika Gupta Department of GI, HPB and Minimal Invasive Surgery, Manipal Hospital, Jaipur, Rajsthan, India

DOI:

https://doi.org/10.18203/2349-2902.isj20190840

Keywords:

Choledochal cyst, Cholangitis, Guidewire, Hepaticojejunostomy, Left hepatic duct, PTBD wire, Prcutaneous transheaptic biliary drainage, Redohepatcojejunostomy

Abstract

This is a rare case of surgical removal of intrahepatic retained broken wire of percutaneous transheaptic biliary catheter, which caused cholagitis and severe pain in a 59-year-old female who had undergone percutaneous transhepatic biliary dilatation of stricture hepaticojejunostomy in past. This is rare case ever reported of surgical removal of a broken PTBD wire retained inside left biliary system, post percutaneous transhepatic biliary dilatation of biliary stricture. Patient also underwent redo-hepaticojejunostomy for treatment of stricture hepaticojejunostomy in same sitting. This guidewire was put by interventional radiologist for dilatation of hepaticojejunostomy stricture. Patient had developed stricture in hepaticojejunotostomy which was done in year 2007 along with choledochal cyst excision by some other Gastrosurgeon. But one reoperation as well as one interventional approach had failed to retrieve the wire retained in biliary system. After that we successfully operated this challenging case and cured her of stricture hepaticojejunostomy, cholagitis and removed the foreign body in one surgery. Postoperatively we followed her up of 2 yrs. Patient is afebrile ,free of jaundice and has normal LFT on 2 yrs of follow up.

Broken guidewire during percutaneous intervention in obstructed biliary system is an emergency as it acts as foreign body, removal with reansatomosis gives a fair chance of cholangitis free survival to patient.

References

Lal R, Agarwal S, Shivhare R, Kumar A, Sikora SS, Saxena R, Kapoor VK. Type IV-A choledochal cysts: a challenge.J Hepatobiliary Pancreat Surg. 2005;12(2):129-34.

Hsien-Tzu L, Hsiuo Shan T, Nai Chi C, Yi Yang L, Yi You C, Chien An L. Percutaneous transhepatic techniques for retrieving fractured and intrahepatically dislodged percutaneous transhepatic biliary drainage catheters. Diagn Interv Radiol. 2017;23(6):461-4.

Datta G.Broken guidewire - A tale of three cases. Indian Heart J. 2015;67 Suppl 3:S49-52.

Krone RJ. Successful percutaneous removal of retained broken coronary angioplasty guidewire. Cathet Cardiovasc Diagn. 1986;12(6):409-10.

Bezirdjian DR, Tisnado J, Cho SR. Percutaneous retrieval of a broken Lunderquist guidewire from the pelvicalyceal system. Southern Med J. 1989 Oct;82(10):1269-71.

Khong PL, John PR. Percutaneous retrieval of a fractured biliary guidewire from a reduced liver graft. Pediatr Radiol. 1997 Mar 1;27(3):253-4.

Guan X, Wu X, Fan G, Zhao S, Gu G, Zhang H, Gu X, He S. Endoscopic retrieval of a broken guidewire during spinal surgery. Pain Physician. 2016 Feb 1;19(2):E339-42.

Khan SM, Ho DW, Dinaram T, Lazar JM, Marmur JD. Conservative management of broken guidewire: Case reports. SAGE Open Med Case Rep. 2014 Oct 14;2.

Kwan JR, Low KSH, Lohan R, Shelat VG. Percutaneous transhepatic biliary drainage catheter fracture: A case report. Ann Hepatobiliary Pancreat Surg. 2018 Aug;22(3):282-286.

Quencer KB, Tadros AS, Marashi KB, Cizman Z, Reiner E, O'Hara R, et al. Bleeding after Percutaneous Transhepatic Biliary Drainage: Incidence, Causes and Treatments. J Clin Med. 2018 May 1;7(5).

Azeemuddin M, Turab N Al Qamari, Chaudhry MBH, Hamid S3, Hasan M, Sayani R. Percutaneous Management of Biliary Enteric Anastomotic Strictures: An Institutional Review. Cureus. 2018 Feb 26;10(2):e2228.

Downloads

Published

2019-02-25

Issue

Section

Case Reports