Gastrointestinal

Gastrointest Radiol 8:149 150 (1983)

Radiology 9 Springer-Verlag 1983

Percutaneous Placement of a Transcystic Duct Internal Biliary Drainage Catheter Rodger W. Shaver 1 and John Soong 2 Departments of Radiology, 1 University of Florida and 2 Gainesville VA Medical Center, Gainesville, Florida, USA

Abstract. A case is described in which a Ring bili-

Key words: Percutaneous cholecystostomy- Bili-

ary drainage catheter was positioned in the duodenum following percutaneous cholecystostomy. Percutaneous cholecystostomy allows biliary intervention in selected patients.

ary drainage.

Address reprint requests to: Rodger W. Shaver, M.D., Dept.

of Radiology, Ft. Myers Comm. Hospital, Ft. Myers, FL 33901, USA

Removal of common duct stones through the cystic duct after surgical cholecystostomy has been described [1, 2]. Following cholecystostomy it is possible, often with the aid of a steerable catheter,

Fig. 1. A Transcystic duct cholangiogram demonstrates gallstones and a distal common duct stone. B An 8.3 F Ring catheter is placed through cystic duct into the duodenum

150

R.W. Shaver and J. Soong: Biliary Drainage by Percutaneous Cholecystostomy

to traverse the cystic duct in most cases. We have a growing experience with percutaneous cholecystostomy, and the following case report describes the successful placement of an internal drainage catheter following percutaneous cholecystostomy.

Case Report A 51-year-old man with a history of angina pectoris presented with a l-week history of right upper quadrant pain, fever, and dark urine. Admission bilirubin was 12.8 mg/dl with a direct fraction of 10.8 mg/dl. Serum electrolytes were abnormal secondary to vomiting. Abdominal ultrasound demonstrated gallstones and dilated common duct without evidence of intrahepatic duct enlargement. When transhepatic attempts to enter the nondilated system were unsuccessful, the gallbladder was entered using a right anterior axillary line approach. Transcystic duct cholangiogram demonstrated gallstones and a 7 mm distal common duct stone (Fig. 1A). A 0.035 in (0.89 mm) guidewire was passed through the cystic duct, and an 8.3 F Ring catheter was positioned with its distal tip in the duodenum (Fig. 1 B). The cystic duct drained well, the patient had no further fever spikes, and the bilirubin fell to 3.3 mg/dl in I week. The initial plan was to perform basket retrieval of both the common duct and gallbladder stones, but the patient's clinical condition stabilized and he underwent cholecystectomy and common duct exploration without complication.

Discussion This case demonstrated that percutaneous placement of transcystic duct internal drainage catheters is possible. Although this patient underwent cholecystectomy, it is likely that his gallstones could have been removed via the cholecystostomy tract.

Percutaneous cholecystostomy has been useful in our management of acute cholecystitis and biliary tract obstruction [3]. To date we have used the procedure in patients considered too unstable or too technically difficult to undergo traditional surgery. It is likely, however, that a number of patients could benefit from percutaneous cholecystostomy and thereby avoid the risk of anesthesia and surgery. In our patient, internal biliary drainage was established; internal drainage has advantages in both nursing care and in maintaining normal nutrition. In addition to the advantage of internal drainage, transcystic duct catheter placement allows such standard transhepatic biliary interventions as stone removal, stricture dilatation, and ductal or pancreatic mass biopsy. This may obviate the need for surgery in selected high-risk patients.

References 1. Amberg Jr, Chun G: Transcystic duct treatment of common bile duct stones. Gastrointest Radiol 6:361-362, 1981 2. Burhenne H J: Non-operative trans-cholecystic removal of common duct stones. Society of Gastrointestinal Radiologists Award Paper, American Roentgen Ray Society Annual Meeting, 12 May 1982, New Orleans, LA 3. Shaver RW, Hawkins IF Jr, Soong J : Percutaneous cholecystostomy. A JR 138:1133-1136, 1982

Received: June 22, 1982; accepted: August 6, 1982