When there is excessive injection into the liver, lymphatics within the liver will be opacified with contrast medium. Įxcessive contrast media injection into the liver should be avoided. The number of attempts made to pass Chiba needle into the biliary tract does not affect the rate of complication but the likehood of success is related to the degree of dilatation of the biliary tract (larger dilatation means needle is easier to find its way into the biliary tract) and total number of attempts made. Meanwhile, the bile ducts in the left lobe of the liver is located to the left side of the xiphisternum on the epigastric region. Bile ducts of the right liver is located in the intercostal spaces between anterior and mid axillary lines. Before the procedure, bedside ultrasound is done to confirm the position of the dilated bile ducts in the liver. Sedation (to reduce irritability and agitation of the subject during procedure) with analgesia (painkillers) and vital signs monitoring should be set up. Besides, antibiotics such as ciprofloxacin 500 mg to 750 mg can be given as antibiotic prophylaxis to prevent infection during the procedure. Those who undergoes the procedure needs to be fasted for four hours before the procedure. Low osmolar contrast medium is used in this procedure with concentration of 150 mg/ml with 20 to 60 ml volume. This procedure is also contraindicated in biliary tract sepsis, except to control the infection by drainage of the infected bile. Contraindications Īmong the contraindications are: increased bleeding tendency where platelets less than 100x10 9/litre and prothrombin time prolonged more than 2 seconds than the control. Rarely it is used for diagnostic purposes only. PTHC is frequently performed guide therapy of the biliary system.
In this rendezvous technique, the guidewire is then pulled into duodenoscope and a small blade is slid over the guidewire into the CBD and perform surgeries on a specific bile duct in the biliary system. Some uses for this procedure includes: drainage of bile/infected bile to relieve obstructive jaundice, to place a stent to dilate a stricture in the biliary system, stone removal, and rendezvous technique where guidewire from the common bile duct (CBD) meets with duodenoscope (coming from the oesophagus into the stomach and then duodenum) at the major duodenal papilla. 6.1 Percutaneous transhepatic technique.6 Percutaneous extraction of retained biliary calculi.5 Percutaneous transhepatic biliary drainage.
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