English (United Kingdom)

https://curated-unify.zendy.io/wp-json/zendy-region/v1/featured_content/oa?rat=en

https://curated-unify.zendy.io/wp-json/zendy-region/v1/highlighted_journal/

Global: Zendy Plus annual

Presents the access of premium content as premium feature

Premium Content

Presents the keyphrase highlighting as premium feature

Keyphrase Highlighting

Presents the summarisation as premium feature

Summarisation

Insights

Presents the pdf analysis as premium feature

PDF Analysis

Presents the zaia usage as premium feature

ZAIA

Global: Zendy Plus monthly

Global: Zendy Tools annual

Global: Zendy Tools monthly

Global: Zendy Free Plan

A 54-year-old woman underwent right trisegmentectomy for liver metastasis from colorectal cancer. One month postoperatively, she developed jaundice. Computed tomography (CT) showed a 16-cm surgical bed fluid collection, drained percutaneously, and intrahepatic ductal dilation. Percutaneous transhepatic cholangiography (PTC) demonstrated complete obstruction of the common hepatic duct (CHD). This could not be crossed, and an 8.5-Fr Dawson–Mueller external biliary catheter (Cook Inc., Bloomington, Indiana, USA) was placed, relieving the jaundice. Endoscopic retrograde cholangiopancreatography (ERCP) demonstrated a 1-cm CHD gap, which could not be traversed by a 0.018-in., 0.021-in., 0.025-in., or 0.035in. straight-tip Jagwire (Boston Scientific, Natick, Massachusetts, USA) (●" Fig.1). On review, it was noted that the patient’s total bilirubin had started rising after her initial trisegmentectomy. Therefore, a complete bile duct transection had most likely occurred intraoperatively. Hepaticojejunostomy was attempted, but was aborted intraoperatively because of the presence of tumor at the intended segment 3 bypass. To reestablish internal biliary drainage, a combined endoscopic and percutaneous rendezvous procedure was planned. Due to left lobe hypertrophy, the hepatic artery and portal vein now lay adjacent to the bile duct defect, necessitating realtime CT during the PTC-ERCP rendezvous. Since the transection could not be traversed with a guidewire, a 5.5F RX needle knife papillotome (Boston Scientific) was advanced percutaneously (●" Fig.2a). Real-time CT demonstrated the relationship between the vessels and the bile duct (●" Fig.3). Ensuring that the needle knife orientationwas lateral to the vessels, the needle knifewas set to endocut for cutting, and then advanced under continuous fluoroscopy (●" Fig.2b–d). Ductal contiFig.1 Endoscopic retrograde cholangiopancreatography (ERCP) with contrast forcefully administered percutaneously and endoscopically, demonstrating complete proximal bile duct transection.

Triple rendezvous using percutaneous, endoscopic, and real-time CT to safely reanastomose bile duct transection following liver resection