Percutaneous transhepatic cholangiodrainage

Percutaneous Transhepatic Cholangiodrainage

Percutaneous Transhepatic Cholangiodrainage (PTCD) is a minimally invasive procedure used to relieve biliary obstruction. This procedure involves the insertion of a catheter through the skin and liver into the bile ducts to allow for external drainage of bile. PTCD is often employed when endoscopic approaches, such as Endoscopic Retrograde Cholangiopancreatography (ERCP), are not feasible or have failed.

Indications

PTCD is indicated in patients with obstructive jaundice due to:

• Malignant biliary obstruction, such as cholangiocarcinoma or pancreatic cancer.
• Benign strictures, such as those resulting from primary sclerosing cholangitis or postoperative complications.
• Biliary leaks following surgery or trauma.

Procedure

The PTCD procedure is typically performed under local anesthesia with conscious sedation. The steps include:

1. Pre-procedural Imaging: Ultrasound or CT scan is used to assess the anatomy and plan the approach. 2. Needle Insertion: A fine needle is inserted percutaneously into the liver under imaging guidance. 3. Cholangiography: Contrast is injected to visualize the biliary tree and identify the site of obstruction. 4. Catheter Placement: A guidewire is advanced through the needle, and a drainage catheter is placed over the guidewire into the bile duct. 5. External Drainage: The catheter is connected to an external drainage bag to allow bile to drain outside the body.

Complications

While PTCD is generally safe, potential complications include:

• Bleeding, particularly if a major blood vessel is punctured.
• Infection, such as cholangitis or abscess formation.
• Bile leakage into the peritoneal cavity, leading to bile peritonitis.
• Catheter dislodgement or blockage.

Post-procedural Care

After PTCD, patients require monitoring for signs of complications. The drainage catheter needs regular care to prevent infection and ensure patency. Follow-up imaging may be necessary to assess the resolution of the obstruction.

Advantages and Limitations

PTCD offers several advantages, including:

• Minimally invasive nature compared to surgical alternatives.
• Ability to provide immediate relief of biliary obstruction.

However, it also has limitations:

• It is a temporary solution, often requiring further intervention.
• It may not be suitable for all patients, particularly those with coagulopathy or ascites.

Also see

• Biliary Drainage
• Cholangiography
• Endoscopic Retrograde Cholangiopancreatography
• Liver Biopsy