[Iatrogenic biliovenous fistula]

A 44-year-old man had suffered from cholecystolithiasis with recurrent jaundice for many years, and a cholecystectomy was carried out. Because of a radiomanometric obstruction of the common bile duct, the intra- and extrahepatic bile ducts were also scanned. One day after the operation the jaundice increased (serum bilirubin max. 742 mumol/l). The cause of the icterus was found in a small biliovenous fistula, and diverse surgical and angiological attempts to resect or close the fistula failed. In the third postoperative week renal failure developed, followed by a disturbance of coagulation and insufficient respiration and circulation. The man died 33 days after the operation. Autopsy showed massive jaundice, gastrointestinal bleeding, and cholemic nephrosis. Extensive preparation of liver resulted in a 20 X 8 X 15 mm fistula in the right lobe 9 cm proximal to the choledochotomy and anastomosing a thin branch of the right hepatic duct and a small hepatic vein. Long-time bilhemia resulted from this fistula and entailed renal failure and finally death. The fistula obviously resulted from scanning the bile ducts when the catheter was accidentally deviated into a biliary duct that was too small.