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synonyms = Percutaneous hepatic cholangiogram|
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'''Percutaneous transhepatic cholangiography''', '''percutaneous hepatic cholangiogram''' ('''PTHC''') is a radiological technique used to visualize the [[anatomy]] of the [[biliary tract]].<ref>{{Citation |last1=Young |first1=Michael |title=Percutaneous Transhepatic Cholangiogram |date=2023 |url=https://www.ncbi.nlm.nih.gov/books/NBK493190/ |work=StatPearls |access-date=2023-11-24 |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=29630242 |last2=Mehta |first2=Dhruv}}</ref> A [[contrast medium]] is injected into a bile duct in the [[liver]], after which [[X-ray]]s are taken. It allows access to the biliary tree in cases where [[endoscopic retrograde cholangiopancreatography]] has been unsuccessful. Initially reported in 1937, the procedure became popular in 1952.<ref>{{cite journal |vauthors=Carter RF, Saypol GM |title=Transabdominal cholangiography |journal=Journal of the American Medical Association |volume=148 |issue=4 |pages=253–5 |year=1952 |pmid=14888454 |doi=10.1001/jama.1952.02930040009002}}</ref><ref>{{cite journal |vauthors=Atkinson M, Happey MG, Smiddy FG |title=Percutaneous transhepatic cholangiography |journal=Gut |volume=1 |issue= 4|pages=357–65 |year=1960 |pmid=13684978 |pmc=1413224 |doi=10.1136/gut.1.4.357}}</ref>
==Uses==
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<ref name="Chapman 2018">{{cite book | vauthors = Watson N, Jones H |title=Chapman and Nakielny's Guide to Radiological Procedures |date=2018 |publisher=Elsevier |isbn=9780702071669 |pages=111-112, 112-113, 117-118}}</ref> 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]]. 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.<ref name="Ayala 2008">{{Cite journal |
PTHC is also used in the drainage of unruptured or uncomplicated hydatid cysts. Rarely, PTHC is used in the drainage of ruptured hydatid cysts.<ref>{{Cite journal |
==Contraindications==
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Excessive contrast media injection into the liver should be avoided. When there is excessive injection into the liver, lymphatics within the liver will be opacified with contrast medium. Injection of the contrast medium into an artery or vein will cause the contrast to dispersed quickly due to blood flow.<ref name="Chapman 2018"/>
Cholangiography during a [[Bile duct#Drainage|biliary drainage]] intervention is called ''perioperative'' or ''primary'' choloangiography, and when performed later in the same drain it is called ''secondary'' cholangiography.<ref name="SchuberthSjogren2010">{{cite journal|last1=Schuberth|first1=O. O.|last2=Sjogren|first2=S. E.|title=On Cholangiography|journal=Acta Radiologica|volume=22|issue=
==Complications==
Percutaneous transhepatic cholangiography may increase the incidence of metastasis, tube dislocation, and bleeding when compared to endoscopic biliary drainage. However, it has lower rate of cholangitis, pancreatitis when compared to endoscopic biliary drainage, probably because the latter has higher chance of incomplete drainage of infected bile, or accidental resection of papilla that causes the backflow of infected bile from the duodenum into the biliary system.<ref>{{Cite journal |
==Percutaneous transhepatic biliary drainage==
Percutaneous transhepatic biliary drainage (PTBD) is often performed if endoscopic retrograde biliary drainage (ERBD) is unsuccessful for biliary obstructions due to [[hepatocellular carcinoma]]. ERBD is the first line treatment because of its low bleeding risk. For biliary obstruction at the hilum (meeting point of right and hepatic hepatic ducts), both ERBD and PTBD can be done depending on subject's clinical circumstances and physician's preference.<ref>{{Cite journal |
==Percutaneous extraction of retained biliary calculi==
===Percutaneous transhepatic technique===
This procedure is indicated when [[endoscopic retrograde cholangiopancreatography]] (ERCP), papillotomy (cutting through [[major duodenal papilla]] to relieve stenosis) or stone removal are unsuccessful. This procedure is also indicated when endoscopic access is difficult in case where there is major modification of the stomach and small intestine such as [[Billroth II]] stomach resection, and other conditions such as intradiverticular papilla (duodenal papilla located inside a duodenal outpouching), stenosis of the duodenal papilla, stone within the distal CBD, stenosis of [[ampulla of Vater]], stone in the peripheral bile duct, or stone larger than 15 mm.<ref name="Ilgit 2002">{{Cite journal |
Biliary calculi is seen on cholangiogram done on T-tube that was previously inserted into CBD. This happens in 3% of the cases post surgical management of biliary stones. This procedure is contraindicated if T-tube is too small (less than 12 French in size), tortous T tube in tissues, [[acute pancreatitis]], and when there is another drain that is connected to the T-tube tract.<ref name="Chapman 2018"/>
PTBD is done one to two weeks before the procedure to reduce oedema of the biliary ducts and [[sphincter of Oddi]] oedema.<ref>{{Cite journal |
Either high osmolar contrast medium or low osmolar contrast medium can be used (with concentration of 150 mg/ml). Low density contrast medium is used to prevent obscuring of the calculus. [[Antibiotic prophylaxis]] and pre-medication is given one hour before the procedure. Painkillers is given during the procedure. The subject lie down in supine position on the table. PTHC is performed if biliary drainage catheter is not in-situ. The drainage catheter is then removed over the guidewire and sheath is inserted into the ducts (7 to 8 French size). Contrast is then injected through the sheath to identify any stones or strictures. If a stricture is identified, put in biliary manipulation catheter with guidewire measuring 0.035 inches and commence balloon dilatation (with balloon sizes of 8, 10, and 12 mm). Using the balloon catheter, the stones are pushed into the duodenum. If the stones are difficult to push, Dormier basket is used to push them into the duodenum. The basket is removed and guidewire is inserted back into the sheath. The sheath is then removed and biliary drainage catheter is inserted back through the guidewire. Contrast is then injected intermittently through the drainage catheter to follow-up on the position of the stones.<ref name="Chapman 2018"/>
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==External links==
* {{MedlinePlusEncyclopedia|003820}}
* [https://
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