P1113 - From Drain Pain to Rendezvous Gain: The Curious Case of the Biliary Re-Route

Christin Wilkinson, MD¹, Jinye Liu, DO², Abdulazeez Swaiti, MD¹, Stephanie Ibarra Lepe, MD², Christina Santana, MD², Amy Chang, MD², Matthew Tugman, BA³, Michelle Cooley, BS³, Catherine Gray, BS³, Saeed Graham, MD¹, MaryKate Kratzer, MD², Karissa Lambert, MD⁴, Hassam Ali, MD¹, Zarak Khan, MD⁴, Rahul Pamarthy, MD¹, Prashant Mudireddy, MD^4
1East Carolina University, Greenville, NC; ²East Carolina University Medical Center, Greenville, NC; ³East Carolina University Brody School of Medicine, Greenville, NC; ⁴East Carolina Gastroenterology, Greenville, NC

Introduction: Rendezvous techniques traditionally combine surgical, endoscopic, and percutaneous methods to access a single point in the body via two pathways. These procedures involve using a snare catheter positioned through the second access point to capture the trailing end of one access wire. When endoscopic retrograde cholangio-pancreatography (ERCP) or percutaneous drainage alone is inadequate, this approach is frequently utilized to manage hepatobiliary issues such as biliary stenosis, stones, injuries, and leaks. We present a case in which biliary rendezvous was performed to internalize a failed external percutaneous biliary drain.

Case Description/Methods: A 46 y/o male s/p laparoscopic cholecystectomy c/b hepatic duct transection with bile leak s/p multiple drains with subsequent Roux en Y hepaticojejunostomy (RYHJ) presented with increasing jaundice, fever, nausea and bilious vomiting. Labs on arrival were significant for a T.bili of 10.2, a Direct bili of 7.2, AST of 128, ALT 173 and Alk phos of 567. Of note, he failed internalization of PTC external drain twice 2/2 to hepatic duct stricture vs stones at the anastomosis site. He underwent an ERCP that showed a severely stenosed RYHJ anastomosis dilated to 8mm with stones swept from biliary tree. Biliary rendezvous was performed to internalize the percutaneous biliary drain to an external internal biliary drain with assistance of IR. IR guidewire was passed percutaneously into the RHD and grasped with regular forceps in the jejunum via endoscopic view with placement of external/internal biliary drain by IR over wire. The patient’s LFTs continued to downtrend and was stable for discharge.

Discussion: Bile duct injuries are a potential complication of cholecystectomy and can range from mild to severe. Complications include bile leaks that can lead to abdominal collections, peritonitis and fistulas, making it important to be treated. The most commonly approved management for post- cholecystectomy BDI is RYHJ. Incidence of stricture formation following biliary-enteric anastomosis is relatively high at 12%, especially in older patients. Cases where there is complete biliary obstruction or severe stenosis causing decreased passage between structures; a combined Rendezvous is a helpful and rare technique that can be used. Further research is needed to help minimize the recurrence and morbidity that is associated with stricture development.



Disclosures:


Christin Wilkinson, MD¹, Jinye Liu, DO², Abdulazeez Swaiti, MD¹, Stephanie Ibarra Lepe, MD², Christina Santana, MD², Amy Chang, MD², Matthew Tugman, BA³, Michelle Cooley, BS³, Catherine Gray, BS³, Saeed Graham, MD¹, MaryKate Kratzer, MD², Karissa Lambert, MD⁴, Hassam Ali, MD¹, Zarak Khan, MD⁴, Rahul Pamarthy, MD¹, Prashant Mudireddy, MD⁴. P1113 - From Drain Pain to Rendezvous Gain: The Curious Case of the Biliary Re-Route, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.