Percutaneous transhepatic biliary drainage, also known as percutaneous transhepatic cholangial drainage (PTCD), is an interventional radiology procedure undertaken for those with biliary obstruction.
It is commonly undertaken as part of palliative biliary stent insertion. Rarely, it is used in the treatment of benign strictures.
Indications
-
malignant obstruction
ampullary and pancreatic malignancies when retrograde access via endoscopic retrograde cholangiopancreatography (ERCP) is not amenable
-
benign obstruction
-
iatrogenic strictures
previous anastomosis (e.g. post-liver transplant)
diathermy burns
hemostasis clips
-
Precautions
If a stent is present in the biliary ducts, the drainage catheter should not be placed in the pigtail conformation as the small wire retaining the shape may get attached to the stent, preventing it's removal.