Internal-external biliary drainage

Case contributed by Dr Paresh K Desai

Presentation

60 year old male with history of being operated for Carcinoma stomach (Gastrojejunostomy - Partial gastrectomy); presents with epigastric lump and jaundice. The CT of the abdomen reveals a recurrent mass in the region of lesser sac and portahepatis; with infiltration of common bile duct causing obstructive jaundice. The patient earlier had a cholecystectomy - clips of which are visible on cholangiogram.

Patient Data

Age: 60
Gender: Male
Modality: Fluoroscopy

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Case Discussion

Percutaneous cholangiography reveals irregular long stricture of the common bile dust with dilated intrahepatic biliary ducts.

The stricture is crossed with a glide wire; which is then exchanged with 0.35" Stiff Amplatz wire over which a internal-External drainage tube is advanced into the duodenum/ gastrojejunostomy site.

There was considerable difficulty advancing the catheter over the stiff wire; the stiffener of which could take 0.25'' wire. Hence two wires were used one of 0.35'' and the other of 0.25'' in parallel and the catheter advanced over the smaller wire taking support of the stiffer bigger wire.

End result reveals successful placement of a internal external drainage tube in the biliary system 

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Case Information

rID: 12251
Case created: 2nd Nov 2010
Last edited: 19th Dec 2015
Inclusion in quiz mode: Included

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