Internal-external biliary drainage

Case contributed by Paresh K Desai
Diagnosis possible


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 porta hepatis 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 years
Gender: Male

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 an 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 an internal-external drainage tube in the biliary system 

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.