ISSN ONLINE: 2558-815X
ISSN PRINT: 1584-9244
ISSN-L: 1584-9244

Percutaneous transhepatic biliary drainage in a patient with malignant stenosis and altered anatomy

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ABSTRACT
Introduction. We present the case of a 72-year-old patient admitted to our hospital with intense jaundice.
Case presentation. Five months previously, he had undergone palliative digestive surgical intervention for massive carcinoma of the uncinate process of the pancreas, which obstructed the duodenal lumen but without biliary obstruction, so a digestive derivation had been performed. The endoscopic retrograde cholangiopancreatography (ERCP) was not an option due to the duodenal malignant obstruction. Therefore, we decided to insert a biliary drainage tube via percutaneous
transhepatic route using ultrasound and radiological guidance. Initially, the evolution was favorable with a bilirubin drop by half. Two weeks later, the patient returns to our hospital with the biliary tube partially migrated outside and with pericatheter leakage. Before retrieving the percutaneous biliary drainage we inserted under X-rays a guidewire which was well placed in the distal duodenum. Afterwards, we extracted the biliary drainage over the guidewire, advanced over the guidewire a biliary dilator and injected contrast to confirm position. Bile drainage was subsequently obtained by percutaneous placement of fully covered self-expandable metal stent (SEMS).
Conclusions. The particularity of the case is the fact that biliary drainage can be difficult to obtain when the anatomy has been modified. In these cases, percutaneous drainage under ultrasound guidance represents an alternative to ERCP, when the duodenum is obstructed and the papillary access is impossible.
Keywords: percutaneous biliary drainage, ultrasound, radiologic guidance.

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