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'''Percutaneous transhepatic cholangiography''', '''percutaneous hepatic cholangiogram''', or '''percutaneous transhepatic cholangiography and drainage''' is a radiological technique used to visualize the [[anatomy]] of the [[biliary tract]]. 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>
==Technique==▼
It is predominantly now performed as a therapeutic technique. There are less invasive means of imaging the biliary tree including transabdominal ultrasound, [[magnetic resonance cholangiopancreatography]], [[computed tomography]] and [[endoscopic ultrasound]]. If the biliary system is obstructed, percutaneous transhepatic cholangiography may be used to perform [[biliary drainage]] until a more permanent solution for the obstruction is performed (e.g. surgery). Additionally, self expanding metal stents can be placed across malignant biliary strictures to allow palliative drainage. Percutaneous placement of metal stents can be utilised when therapeutic endoscopic retrograde cholangiopancreatography has been unsuccessful, anatomy is altered precluding endoscopic access to the duodenum, or where there has been separation of the segmental biliary drainage of the liver, allowing more selective placement of metal stents.{{cn|date=January 2022}}▼
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=5-6|year=2010|pages=780–795|issn=0001-6926|doi=10.3109/00016924109136457}}</ref>▼
==Indications==
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==Contraindications==
Among the contraindications are: increased [[bleeding tendency]] where platelets less than 100x10<sup>9</sup> and prothrombin time prolonged more than 2 seconds than the control. This procedure is also contraindicated in biliary tract sepsis, except to control the infection by drainage of the infected bile.<ref name="Chapman 2018"/>
▲==Technique==
▲It is predominantly now performed as a therapeutic technique. There are less invasive means of imaging the biliary tree including transabdominal ultrasound, [[magnetic resonance cholangiopancreatography]], [[computed tomography]] and [[endoscopic ultrasound]]. If the biliary system is obstructed, percutaneous transhepatic cholangiography may be used to perform [[biliary drainage]] until a more permanent solution for the obstruction is performed (e.g. surgery). Additionally, self expanding metal stents can be placed across malignant biliary strictures to allow palliative drainage. Percutaneous placement of metal stents can be utilised when therapeutic endoscopic retrograde cholangiopancreatography has been unsuccessful, anatomy is altered precluding endoscopic access to the duodenum, or where there has been separation of the segmental biliary drainage of the liver, allowing more selective placement of metal stents.{{cn|date=January 2022}}
▲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=5-6|year=2010|pages=780–795|issn=0001-6926|doi=10.3109/00016924109136457}}</ref>
==Complications==
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