Technique:
Under sterile conditions and general anesthesia, ultrasound-guided gallbladder puncture with a 22-gauge spinal needle passing through the liver. Cholangiography with iodinated contrast medium.
Afterwards, local anesthesia with 1.5 ml of ropivacaine 0.2%. Small incision in the skin. Hepatic biopsy under the ribs with a semi-automatic 16 gauge system. Manual compression for 10 minutes. No hemoperitoneum or traumatic intrahepatic vascular lesion on post-compression ultrasound.
Compression dressing performed.
Findings:
Cholangiography demonstrates an irregular, microlobulated gallbladder, a cystic duct that progressively dilates upon injection, and a network of very fine irregular bile ducts in the hepatic hilum (appearance of cholangiolar proliferation) with progressive enhancement of extensive periportal fibrosis. No opacification of a common bile duct.
The liver biopsy specimen appeared macroscopically adequate, greenish-brownish.
Conclusion:
Transhepatovesicular cholangiography confirming biliary atresia.
Liver biopsy without complication.