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Decompression of Bile Ducts with the Percutaneous Transhepatic Iechnic

1969; Radiological Society of North America; Volume: 93; Issue: 1 Linguagem: Inglês

10.1148/23.1.69

1527-1315

J Kaude, Carl H. Weidenmier, O. Frank Agee,

Cholangiocarcinoma and Gallbladder Cancer Studies

PERCUTANEOUS transhepatic cholangiography (PTC) is valuable for anatomic delineation of biliary duct obstruction. The indications for the procedure, its technic, and the diagnostic implications have been discussed by several authors (6-8), but the usefulness of the procedure for therapeutic purposes has barely been touched upon (1, 3, 4). Usually the puncture needle or catheter is removed immediately after completion of cholangiography or it is left in place for temporary duct decompression until immediately ensuing surgery. Yet, when surgery is postponed or cancelled (inoperability), the catheter may be used for long-term bile drainage. Ahnlund and Morales (1) reported one case in which postcholangiographic biliary decompression was carried out for five weeks. We have used this method to establish prolonged biliary drainage in several patients, the cases of two of whom are reported herein. In one patient bile continued to drain for more than two months following the original puncture. Case Reports CASE I: A 67-year-old Caucasian male with painless obstructive jaundice for eight months. Shortly prior to admission at our institution, a postcholecystectomy T-tube cholangiogram showed partial obstruction of the biliary tract near the junction of the right and left hepatic ducts. Later studies including a liver scan and celiac arteriograms established a diagnosis of biliary tract carcinoma with metastases to both lobes of the liver. The patient, with a serum bilirubin of 20.7 mg/lOO ml and incapacitating pruritus, submitted to PTC prior to anticipated palliative surgery. Simultaneous PTC and T-tube cholangiography showed a 2.5 em complete obstruction of the common hepatic duct (Fig. 1). A polyethylene catheter was inserted through the puncture needle and left in place for drainage with the hope of obviating surgery. In spite of minor adjustments of the tubing during the next few days it did not drain well, and five days after the original puncture, reinjection with contrast material showed the catheter tip to lie outside the biliary tract (Fig. 2). This tube was withdrawn and another successful puncture made with a 2 mm (outside diameter) Teflon tube being left in position (Fig . 3). The patient was placed on antibiotics and observed for several days; no signs of bile peritonitis or intra-abdominal hemorrhage developed. With the new tube draining well the serum bilirubin level dropped from 20.7 to 16.2 mg/100 ml within four days, and the patient's pntritus disappeared. The PTC-tube was connected externally to the patient's T-tube for return of biliary effiuent to the intestinal tract (4, 5), and he was discharged. When the patient was last seen in clinic two months later the catheter was still draining bile. The bilirubin level was 1.8 mg/100 ml, and the alkaline phosphatase level had dropped from 185 to 139 units.