EMBOLIZATION OF CYSTIC DUCT STUMP LEAK FOLLOWING FAILED ENDOSCOPY
We report a case of 79 year-old man with history of complete heart block and multiple morbidities, who presented with nausea, vomiting, and abdominal pain. On examination, the patient was found to have distended abdomen with tenderness at the right upper quadrant. Ultrasound and contrast enhanced abdominal CT showed a distended gallbladder, gall bladder wall thickening with increased pericholecystic fat density which was consistent with acute cholecystitis. A subphrenic and pericholecystic fluid collection and fluid tracking in-between bowel loops raised the concern of a perforated gallbladder. Laparoscopic abdominal exploration revealed a necrotic gallbladder. A drainage catheter was left in the gallbladder fossa after its laparoscopic removal. Complicated postoperative course with abdominal pain and high bilious output was observed despite endoscopic placement of plastic stent and later a covered metal stent to seal a cystic duct stump biliary leak. We performed percutaneous embolization of the leaking cystic duct stump using a combination of coils and gelatin sponge torpedoes. To our knowledge, this technique has not been previously described in literature.