Diagnostic and Therapeutic Endoscopy, Vol. 3, pp. 67-72 Reprints available directly from the publisher Photocopying permitted by license only (C) 1996 OPA (Overseas Publishers Association) Amsterdam B.V. Published in The Netherlands by Harwood Academic Publishers GmbH Printed in Singapore Endoscopic Treatment of Postoperative External Biliary Fistula in a Patient Operated on for Hepatic Injury Due to Multiple Trauma MARCO DE MONTI*’t, DAVIDE SONNINO, MARINA GORZIGLIA, GIORGIO REDAELLL and MARCELLO SCARPIS Department of General Surgery (D.S., M.G., G.R.), Digestive Endoscopy Service (M.S.), and S.S.U.Em. 118 (M.D.M.), General Hospital ofMenaggio, Como, Italy (Received 26 January 1996; Infinalform 20 March 1996) After surgery for hepatic injury as a result of blunt abdominal trauma from a motorcy- cle accident, an external biliary fistula developed in a young patient. The authors describe the rapid and complete healing of the fistula by use of a nasobiliary catheter. These findings emphasize the importance of endoscopic operative technique for postop- erative and traumatic external biliary fistulas. Keywords: External biliary fistula, endoscopic retrograde cholangiopancreatography, nasobiliary catheter INTRODUCTION External biliary fistula is a possible complication of Fistulous drainage may cause significant fluid and hepatic trauma or hepatic surgery. It can also be a electrolyte losses, requiring prolonged hospitalization. result of elective biliary surgery for lithiasis, neo- plasm, or echinoccosis 1,2]. Its incidence is estimated Surgical therapy of external biliary fistulas is often associated with high morbidity (50%) [7] and mortal- to be 0.1 to 0.3% of all biliary operations [3]. ity due to procedures performed in inflamed and sep- Biliocutaneous fistulas due to spontaneous drainage of tic tissues. biliary or hepatic abscesses are extremely rare [4]. Endoscopic operative procedures represent a valid Untreated blunt hepatic trauma can cause external fis- and often successful treatment for these kinds of com- tulas in about 4% of all patients [5]. plications in biliary surgery: endoscopic retrograde Causes of postoperative biliocutaneous fistulas cholangiopancreatography (ERCP) permits extremely include residual lithiasis, distal stenosis, premature precise diagnosis and allows biliary drainage through removal of Kehr tubes, and iatrogenic injury or acci- dental ligation of the common biliary duct [6]. *Corresponding author. tPresent address: Via Derna 5,1-20132 Milano, Italy. 67