A 43-year old woman was admitted 11 days after open cholecystectomy with a iatrogenic bile
duct injury. On admission the patient showed an uncontrolled biliary fistula through an external
drain placed at an emergency laparotomy for biliary peritonitis with fever and jaundice. PTC
showed a biliary stricture type II (Bismuth). A percutaneous drainage was performed to
decompress the biliary system. Three weeks later, percutaneous balloon dilatation of the
stricture was performed. However, bile leakage persisted. In a combined transhepatic/
endoscopic procedure, the percutaneous biliary drainage was replaced by a nasobiliary tube.
One week later, no stricture was found and the biliary leak was sealed. The patient could be
discharged without symptoms or signs of cholestasis. The multidisciplinary management of
post-operative biliary fistula is presented, comparing the role of interventional radiology,
endoscopy and surgery.