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ERCP and Stent Placement

[ Fixing a Bile Duct Leak ]


Stent Draining Bile Duct

This photo is an example of how ERCP can be used to treat an uncommon, but major, complication of gallbladder surgery - a bile duct leak. What you see is the end of a plastic tube called a stent which is protruding from the bile duct from the wall of the small intestine. This stent was placed into the leaking bile duct during ERCP. The stent bypasses the leak and allow the bile duct to heal without the need for major surgery. Read on for a more detailed explanation....

Anatomy
First some anatomy.... Your liver has many jobs to perform. One is making bile, a bitter yellow liquid which helps the small intestine digest your food. Bile is collected by a series of small hollow tubes called bile ducts. These ducts come together - much like the branches of a tree - to form a main trunk. Named the common bile duct, this trunk drains into the intestine through a small nipple called the Ampulla of Vater. Halfway down the main trunk is a side branch which empties into the gallbladder. Your liver makes bile 24 hours a day. The gallbladder pouch stores and concentrates extra liver bile between meals. When you eat, the gallbladder contracts and bile enters the small intestine to help digest your food.

Stent Loaded on Insertion Catheter
This is a the case of a 35 year old women who was admitted to the hospital with severe abdominal pain. Three days before, her gallbladder had been removed due to a bad case of gallstones. The operation was done by laparoscopy, or "bandaid" surgery using three small incisions. She expected a prompt recovery with very little pain. But after discharge from the hospital, her pain became worse and she returned.

A emergency CT Scan x-ray demonstrated a large amount of liver bile leaking out of the bile ducts and into the abdominal cavity. This meant that she had an uncommon serious complication from her gallbladder surgery - a leak had formed in one of the bile ducts and bile was spilling out into her abdominal cavity. Within the abdominal cavity, liver bile is a very irritating substance. It is like putting acid on an open wound.

Because of this bile leak and her recent sugery, her surgeon felt that it would be very difficult to reoperate. Instead, Dr. Stanley was consulted and asked to perform an ERCP procedure. By using a videoscope passed through the mouth while the patient was sedated, he located the nipple-like Ampulla in the wall of the upper small intestine and placed a special drain (stent) up into the main common bile duct stopping the leak and allowing the bile duct to heal. The procedure only took about 20 minutes. Because of the sedation, the patient didn't feel a thing.

This photo shows the blue stent loaded onto an thin catheter which is passed through a channel in the ERCP scope. Under direct vision on the TV monitor, the doctor placed the stent through the ampulla and into the bile duct. This allowed the liver bile to bypass the area of leak and drain normally. Her pain was gone in within 24 hours and she was released. The stent will be kept in place for about a month and then simply removed during a second scope procedure. This is a good example of how ERCP can be used to avoid major surgery and salvage a bad situation such as this post-operative complication.


Text & Images Courtesy of Three Rivers Endoscopy Center
© Dr. Robert Fusco, Three Rivers Endoscopy Center, All Rights Reserved





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