Percutaneous transhepatic biliary drainage, balloon dilation of the common hepatic duct, and external/internal biliary drainage catheter placement.
The procedure was performed in the patient who developed dilation of the biliary tree after Roux-en-Y surgery. MR demonstrated significant narrowing of the biliary intestinal anastomosis. The procedure, possible risks, benefits and alternatives were discussed with the patient and consent was obtained. The procedure was performed with routine aseptic technique, under general anesthesia, using fluoroscopic guidance. The intercostal space along the right mid axillary line was selected for the approach. A 21-gauge needle was introduced into the biliary tree that was opacified with injection of Visipaque. The study confirmed presence of the stenosis of the biliary intestinal anastomosis and demonstrated presence of intra hepatic biliary stones. The posterior right biliary duct containing a biliary calculus was selected and, using Seldinger technique, an 9 French angiographic sheath was introduced. A catheter and guidewire were advanced through the biliary intestinal anastomosis into the Roux loop. Then, the anastomosis was dilated with a 9 mm angioplasty balloon. There was an apparent waist on the balloon at the area of the anastomosis. The waist was completely eliminated after the balloon inflation. The biliary stones were successfully washed from the intra hepatic biliary radicles into the intestinal loop. A 14 French biliary drainage catheter was placed with the self-retaining loop formed within the intestine. The function of the catheter was verified by injection of contrast material. The catheter was affixed to the skin with suture and capped; sterile dressing
was applied. The peak skin dose was 308 T 9.1 mGy.[/LEFT][/CENTER]
The procedure was performed in the patient who developed dilation of the biliary tree after Roux-en-Y surgery. MR demonstrated significant narrowing of the biliary intestinal anastomosis. The procedure, possible risks, benefits and alternatives were discussed with the patient and consent was obtained. The procedure was performed with routine aseptic technique, under general anesthesia, using fluoroscopic guidance. The intercostal space along the right mid axillary line was selected for the approach. A 21-gauge needle was introduced into the biliary tree that was opacified with injection of Visipaque. The study confirmed presence of the stenosis of the biliary intestinal anastomosis and demonstrated presence of intra hepatic biliary stones. The posterior right biliary duct containing a biliary calculus was selected and, using Seldinger technique, an 9 French angiographic sheath was introduced. A catheter and guidewire were advanced through the biliary intestinal anastomosis into the Roux loop. Then, the anastomosis was dilated with a 9 mm angioplasty balloon. There was an apparent waist on the balloon at the area of the anastomosis. The waist was completely eliminated after the balloon inflation. The biliary stones were successfully washed from the intra hepatic biliary radicles into the intestinal loop. A 14 French biliary drainage catheter was placed with the self-retaining loop formed within the intestine. The function of the catheter was verified by injection of contrast material. The catheter was affixed to the skin with suture and capped; sterile dressing
was applied. The peak skin dose was 308 T 9.1 mGy.[/LEFT][/CENTER]
