PMC6360323_01
X-ray fluoroscopic examination on the 28th postoperative day, showing (A) the flow to the anterior branch of the right intrahepatic bile duct and the cannulated guide wire (white arrow). (B) The guide wire was advanced toward the jejunum via the junction of choledochojejunostomy under the assistance of 5Fr. Cobra-type catheter (black arrow).
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Nine days after the second surgery, bile leakage from the indwelling drainage tube occurred, forming an abscess cavity (Fig. 1). An indwelling drainage tube was inserted from the junction of the pancreatoduodenectomy to outside the body, via the abscess cavity (Fig. 1).
(A) Enhanced computed tomography (CT) on the 9th postoperative day. The abscess cavity had formed around the surface of the hepatectomy from the bile duct injury point (dashed line), showing the indwelling drainage tube (white arrow). (B) Enhanced CT on the 20th day after the intervention, showing the Cobra catheter in the bile duct (black arrow). The abscess cavity had almost disappeared (white arrowhead).
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Plane computed tomography (CT) showed that the cavity had reduced in size and almost disappeared 20 days after the intervention (Fig. 2).
X-ray fluoroscopic examination on the 41st postoperative day. (A) The catheter was in the branch of the right intrahepatic bile duct (white arrow), and no leakage was detected. (B) The external fistula was completely formed (black arrow), and there was no abscess.
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Forty-one days after the intervention, when the external fistula was formed, we removed the tube (Fig. 3).