# A case of an intraabdominal, but extrahepatic ruptured percutaneous transhepatic biliary drainage and its following rescue. A case report and literature review

## TL;DR

This case report describes a complication of a biliary drainage procedure and the successful rescue treatment in an elderly patient with a history of cancer.

## Contribution

The paper introduces a novel subcutaneous fixation technique to prevent drain dislodgement.

## Key findings

- A fractured intrahepatic drain led to biliary peritonitis and clinical deterioration.
- The fractured drain was successfully extracted in the angio suite.
- The case highlights the importance of preventative measures in managing drainage complications.

## Abstract

Percutaneous transhepatic biliary drainage is a well-established technique for the treatment of biliary obstruction in patients with failed endoscopic approaches. We report on an 82-year-old man with a history of cholangiocarcinoma treated with pancreaticoduodenectomy who presented with recurrent cholangitis and sepsis. Percutaneous transhepatic biliary drainage was performed after unsuccessful endoscopic retrograde cholangiography, which initially improved his condition. However, due to an accidental dislodgement, there was an intra-abdominal fracture of the drain which led to biliary peritonitis and clinical deterioration. The fractured intrahepatic drain was successfully extracted in our angio suite, and a novel subcutaneous fixation technique was introduced to prevent similar occurrences in the future. This case study signifies the role of interventional radiology in the management of percutaneous transhepatic biliary drainage complications and the importance of preventative measures to avoid dislodgement.