Successful Management of a Completely Disconnected Bile Leak After Hepatectomy Using Endoscopic Ultrasound‐Guided Transluminal Drainage of a Biloma: A Case Report

ABSTRACT Post‐hepatectomy bile leak is a common postoperative complication. It usually resolves spontaneously but may be refractory. In cases of completely disconnected bile ducts, endoscopic retrograde cholangiopancreatography (ERCP)–guided drainage is often technically difficult, and invasive additional procedures may be required. We report a completely disconnected bile leak after hepatectomy successfully treated with endoscopic ultrasound‐guided transluminal drainage (EUS‐TD) after unsuccessful EUS‐guided biliary drainage (EUS‐BD). A 78‐year‐old woman underwent anterior sectionectomy for recurrent hepatocellular carcinoma and developed persistent bile leakage. ERCP showed complete disruption of the right posterior sectoral bile duct, and guidewire passage was impossible. EUS‐BD failed because of the nondilated bile duct; therefore, the bile leak‐associated infected biloma was drained through an endoscopically created route under EUS guidance. The infected biloma showed significant shrinkage, and the patient was discharged without complications. EUS‐TD may represent an alternative therapeutic option for completely disconnected bile leaks when EUS‐BD is technically difficult.