PMC5244888_01
Fluoroscopic image showing a 0.035-inch wire passed from the endoscope being snared from the percutaneous access in the anomalous transected right anterior bile duct.
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F1
The transected duct was then endoscopically accessed using an EchoTip Ultra HD 19g FNA needle (Cook Medical, Bloomington, IN), through which a 0.035-inch Glidewire (Terumo, Somerset, NJ) was passed through the endoscopic needle into the biliary tree. The Glidewire was snared via the percutaneous access with a gooseneck snare (ev3, Plymouth, MN) and withdrawn through the sheath (Figure 1).
Fluoroscopic image showing the 8-French internal-external biliary drainage catheter crossing the newly created hepaticojejunostomy and terminating in the afferent bowel loop. The safety wire extends from the transected bile duct into the subhepatic space.
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F2
An 8-French internal-external biliary drainage catheter was then advanced over the wire from the transected duct into the afferent limb to create a new hepaticojejunostomy (Figure 2).
Endoscopic image demonstrating Viabil stent in place at the newly created hepaticojejunostomy.
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F3
Approximately 3 months after the de novo hepaticojejunostomy creation, the percutaneous drain was removed over a wire and a 10 mm x 60 mm Viabil stent (Gore, Flagstaff, AZ) was placed endoscopically (Figure 3).
Endoscopic image demonstrating the hepaticojejunostomy orifice after removal of the Viabil stent.
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F4
Endoscopic visualization of the percutaneous and endoscopically created hepaticojejunostomy orifice showed it to be widely patent (Figure 4).
Endoscopic cholangiogram after removal of the covered metallic stent showing a patent hepaticojejunostomy without stricture or leak.
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F5
Endoscopic cholangiogram after stent removal demonstrated a patent hepaticojejunostomy without stricture or leak (Figure 5).