Int J Gastrointest Interv 2019; 8(1): 41-44  https://doi.org/10.18528/ijgii180037
Percutaneous-transhepatic creation of a bilioenteric neoanastomosis in a patient with bile duct injury using cone-beam computed tomography
Nathan Wnuk1,* , Ana Maria Pabon-Martinez1, Armeen Mahvash2, Gouthami Chintalapani3, Thomas A. Aloia4, and Bruno C. Odisio2
1MD Anderson Cancer Center, Houston, TX, USA
2Department of Vascular and Interventional Radiology, MD Anderson Cancer Center, Houston, TX, USA
3Siemens Medical Solutions USA Inc., Hoffman Estates, IL, USA
4Department of Surgical Oncology, Division of Surgery, MD Anderson Cancer Center, Houston, TX, USA
MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA. E-mail address: nathan.wnuk@gmail.com (N. Wnuk). ORCID: https://orcid.org/0000-0002-2720-0120
Received: October 4, 2018; Revised: December 30, 2018; Accepted: December 30, 2018; Published online: January 31, 2019.
© Society of Gastrointestinal Intervention. All rights reserved.

cc This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
We describe the creation of a percutaneous transhepatic bilioenteric neoanastomosis with the aid of cone-beam computed tomography (CBCT) in a patient suffering from a complicated bile leak after extensive hepatobiliary surgery. Access to the afferent bowel limb was safely performed in a single-stick manner via transhepatic approach with the aid of real-time navigation fluoroscopic imaging generated by CBCT arteriography. CBCT confirmed access of the afferent limb and absence of peri-anastomotic vessel damage, allowing the successful creation of a bilioenteric neoanastomosis, resolving the patient’s biliary leak. The patient is alive and asymptomatic at 12-month follow-up, demonstrating patency of the percutaneous bilioenteric neoanastomosis.
Keywords: Biliary intervention; Bilioenteric neoanastomosis; Cone-beam computed tomography; Fusion imaging; Percutaneous intervention


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