Percutaneous transhepatic biliary drainage
A case of gallbladder malignancy extending to involve CBD, with resultant IHBR dilatation. ERCP guided CBD stenting was performed successfully. However, the stent blocked in one month. Patient developed pain and total bilirubin levels raised to 13. Patient was then taken up for PTBD.
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Image 1: Initial Chiba needle guided biliary system opacification.
Image 2: Cobra catheter in situ with biliary system opacification. Chiba needle is also seen.
Image 3: Kinked pigtail drainage catheter due to ascites.
Image 4: A 7 Fr. long sheath in biliary system for drainage.
Chiba needle guided opacification of biliary system was performed.
Pink hub needle guided puncture of right duct system followed by 4Fr. C1 catheter insertion over Terumo Glide wire was performed.
Amplantz stiff wire was then inserted till duodenum though Cobra catheter.
Because of ascites, the pigtail drainage catheter could not be inserted into the biliary duct system (it was getting kinked).
Eventually, A 7 Fr. long sheath was kept in biliary system and sutured externally to skin.
PTBD is one of the most essential procedures in cases with dilated IHBR due to failed ERCP stenting, blocked CBD stent, Distal CBD lesion with stenting not possible and in cases with non dilated system with CBD injury.
If meticulously performed, this procedure is technically feasible in all cases with good success rate.
It gives immediate sympomatic relief as well as brings down the levels of bilirubin down.
Once bilary system edema subsides, internalisation of PTBD drainage cather followed by PTBD guided biliary stenting is possible.
- September 2003, Volume 181, Number 3 Single-Wall Puncture: A New Technique for Percutaneous Transhepatic Biliary Drainage SH Lee et al
- Ann Surg. 1983 July; 198(1): 25–29. Percutaneous transhepatic biliary drainage. Complications due to multiple duct obstructions. ME Clouse et al.