In patients with liver transplantation, biliary and vascular complications are still very important elements of postoperative morbidity and mortality. This study documents unusual methods for treating biliary complications in this patient group. Of 57 patients who underwent orthotopic or heterotopic liver transplantation between 1995 and 2003, 3 developed biliary leakage and were successfully treated. Two of the patients had undergone choledocho-jejunostomy and had developed bile leakage at the anastomosis site. The third patient had leakage at the choledochocholedochal anastomosis. In each case, a catheter was placed percutaneously to the bile collection to drain the leaking bile. Sinograms showed an cavity below the transplant liver and filling of the jejunum in two patients, and a distal choledoc in the other patient. In these patients, the drainage catheter access was used to advance a guide-wire into the intestine and placed a multi-holed drainage catheter so that the holes stayed in the bile collection and intestine. In the patient with choledochocholedochal anastomosis, a plastic stent was advanced from the papilla through the choledochocholedochal anastomosis into the perihepatic collection.
In two patients with choledocho-jejunostomy, the leakage resolved within days and the catheters were removed between 2 and 6 weeks. In the individual who initially had a plastic stent placed, the stent became occluded and the patient had to be treated percutaneously. Bile leaks in liver transplant recipients who have undergone choledocho-jejunostomy and have non-dilated biliary systems can be treated with percutaneous placement of a drainage catheter across the leakage site.