Refractory Intrahepatic Bile Leak in a Young Patient After Blunt Abdominal Trauma: Technique of Endoscopic Management Using Cyanoacrylate Glue-Lipiodol Combination

ABSTRACT Bile leaks are commonly managed endoscopically with either sphincterotomy and/or biliary stenting. Historically, if these procedures failed, surgery was inevitable, carrying high morbidity. Data are sparse on the management of persistent or refractory bile leaks after failed endoscopic retrograde cholangiopancreatography. We report a young patient, following blunt abdominal trauma, managed with percutaneous catheter drains for bilomas. Ongoing bilious output in the perihepatic drain persisted, despite 3 sessions of biliary stenting and subsequent stent upgradations. Definitive management was achieved by endoscopic injection of glue-lipiodol (1:1) at the leak site under real-time fluoroscopic guidance, highlighting a minimally invasive alternative to surgery.