Endoscopic use of a biodegradable biliary stent in the management of a complex bile duct injury - Case report

Sep 29, 2026

Uploaded by Cipher

Endoscopic retrograde cholangiopancreatography (ERCP) with stent therapy for a Strasberg type D bile duct injury following laparoscopic cholecystectomy. A man in his 50s developed sepsis and a large biloma after an initially missed minor bile leak; ERCP with a plastic stent and percutaneous drainage resolved the leak but left a persistent severe common hepatic duct stricture. A polydioxanone-based biodegradable biliary stent was then placed, achieving complete stricture resolution and improved ductal patency at 6 months without complications. The case highlights biodegradable stents as a minimally invasive option for complex biliary injuries.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages4

Reading Time10 min

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Summary

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Case report Endoscopic use of a biodegradable biliary stent in the management of a complex bile duct injury Mohammed Fathy Zaky , 1 Emad Abdelwahab Turky, 1 Khalid Ibrahim Bzeizi,2 Ali Hussain Albenmousa,2 Ahmad Nasr Alghitany,3 Atef Faisal Bassas,4 Amr Youssef Arkoubi5 1Gastroenterology, Saudi German Hospital Riyadh, Riyadh, Saudi Arabia 2Adult Transplant Gastro & Hepatology Section, King Faisal Specialist Hospital and Research Centre, Riyadh, Riyadh Province, Saudi Arabia 3Internal Medicine, Saudi German Hospital Riyadh, Riyadh, Saudi Arabia 4Hepatobiliary section, Saudi German Hospital Riyadh, Riyadh, Saudi Arabia 5Saudi German Hospital Riyadh, Riyadh, Saudi Arabia Correspondence to Dr Mohammed Fathy Zaky; dr. mohammedfathy@hotmail. com Accepted 12 December 2025 © BMJ Publishing Group Limited 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group. To cite: Zaky MF, Turky EA, Bzeizi KI, et al. BMJ Case Rep 2025;18:e268480 . doi:10 . 1136/bcr-2025- 268480 SUMMARY A man in his 50s sustained a Strasberg type D bile duct injury during laparoscopic cholecystectomy, which was initially misdiagnosed as a minor bile leak. Upon referral, he presented with abdominal pain, sepsis and a large biloma. Endoscopic retrograde cholangiopancreatography (ERCP) with plastic stent placement and percutaneous drainage resolved the leak, but a severe stricture of the common hepatic duct persisted. A biodegradable polydioxanone-based biliarystent was subsequently deployed, resulting in complete stricture resolution and improved ductal patency at 6-month follow-up, with no complications. This case illustrates the potential role of biodegradable stents in managing complex biliary injuries. BACKGROUND Biliary tract injuries are a recognised complication of laparoscopic cholecystectomy and may result in bile leaks, strictures or fistula formation if not promptly diagnosed and treated. Strasberg type D injuries, which involve the common hepatic duct, usually require surgical reconstruction. However, in the presence of sepsis or significant inflammation, surgical intervention may pose substantial risks. Recent developments in biodegradable biliarystents offer a novel, minimally invasive alternative by providing temporary ductal support without the need for later removal. These stents may reduce the frequency of interventions and associated complications. This case report describes the first documented endoscopic use of a biodegradable biliarystent for a complex bile duct injury in Saudi Arabia and evaluates its short-term outcomes. CASE PRESENTATION A man in his 50s with a medical history of hypertension underwent laparoscopic cholecystectomy. He was initially diagnosed with a minor bile leak but re-presented 1 week later with persistent right upper quadrant pain and low-grade fever. MRI identified a large fluid collection (biloma) and an abrupt ductal cut-off at the level of the hepatic duct. The patient was initially treated conservatively with an ultrasound-guided pigtail drainage of the localised biloma, which was removed before his discharge. He was referred to our tertiary care unit, where he was febrile and exhibited clinical signs of early sepsis for further evaluation and management. INVESTIGATIONS The initial laboratory evaluation demonstrated a predominantly cholestatic pattern of liver injury, with markedly elevated alkaline phosphatase (303 U/L) and γ-glutamyl transferase (504 U/L), accompanied by moderate elevations in transaminases (aspartate aminotransferase (AST) 94 U/L, alanine aminotransferase (ALT) 191 U/L) and a mild rise in total and direct bilirubin (1.99 mg/dLand 0.62 mg/dL, respectively). Notably, the C-reactive protein (CRP) level was markedly elevated at 288.9 mg/L, and procalcitonin 2.6 ng/mL, indicating a significant inflammatory response and early sepsis. The MRI demonstrated a post-cholecystectomy large operative bed collectio

FAQs

What injury and initial misdiagnosis occurred after laparoscopic cholecystectomy?

A man sustained a Strasberg type D bile duct injury, initially misdiagnosed as a minor bile leak. After referral, he presented with abdominal pain, sepsis, and a large biloma.

How was the bile leak managed before the stricture was treated?

ERCP with plastic stent placement together with percutaneous drainage resolved the bile leak. Culture from drainage grew Klebsiella pneumoniae.

Why was a biodegradable stent used later, and what was the outcome?

A severe stricture persisted after resolution of the leak, and the plastic stent subsequently migrated below the stricture level. A polydioxanone-based biodegradable stent was used, leading to complete stricture resolution and improved ductal patency at 6-month follow-up with no complications.

Sep 29, 2026

Uploaded by Cipher