Complications of percutaneous transhepatic biliary drainage in patients with dilated and nondilated intrahepatic bile ducts

Percutaneous transhepatic biliary drainage (PTBD) have been described as an effective technique to obtain biliary access. Between January 1996 and December 2006, a total of 419 consecutive patients with endoscopically inaccessible bile ducts underwent PTBD. The current retrospective study evaluated success and complication rates of this invasive technique. PTBD was successful in 410/419 patients (97%). The success rate was equal in patients with dilated and nondilated bile ducts (p = 0.820). In 39/419 patients (9%) procedure related complications could be observed. Major complications occurred in 17/419 patients (4%). Patients with nondilated intrahepatic bile ducts had significantly higher complication rates compared to patients with dilated intrahepatic bile ducts (14.5% vs. 6.9%, respectively [p = 0.022]). Procedure related deaths were observed in 3 patients (0.7%). In conclusion, percutaneous transhepatic biliary drainage is an effective procedure in patients with dilated and nondilated intrahepatic bile ducts. However, patients with nondilated intrahepatic bile ducts showed a higher risk for procedure related complications.     

Complications of percutaneous transhepatic biliary drainage in patients with dilated and nondilated intrahepatic bile ducts

Percutaneous transhepatic biliary drainage (PTBD) have been described as an effective technique to obtain biliary access. Between January 1996 and December 2006, a total of 419 consecutive patients with endoscopically inaccessible bile ducts underwent PTBD. The current retrospective study evaluated success and complication rates of this invasive technique. PTBD was successful in 410/419 patients (97%). The success rate was equal in patients with dilated and nondilated bile ducts (p = 0.820). In 39/419 patients (9%) procedure related complications could be observed. Major complications occurred in 17/419 patients (4%). Patients with nondilated intrahepatic bile ducts had significantly higher complication rates compared to patients with dilated intrahepatic bile ducts (14.5% vs. 6.9%, respectively [p = 0.022]). Procedure related deaths were observed in 3 patients (0.7%). In conclusion, percutaneous transhepatic biliary drainage is an effective procedure in patients with dilated and nondilated intrahepatic bile ducts. However, patients with nondilated intrahepatic bile ducts showed a higher risk for procedure related complications.     

Normal intrahepatic bile ducts: CT depiction

Visualization of intrahepatic bile ducts (IHBDs) at computed tomography (CT) has previously been considered evidence of biliary obstruction. The authors have found that hepatic CT enhanced with contrast material and with the use of ceramic scintillation detectors allows frequent visualization of normal IHBDs. One hundred patients without imaging, laboratory, or clinical evidence of hepatobiliary or pancreatic disease were prospectively examined to assess the frequency of visualization, location, and size of IHBDs. IHBDs were visualized in 40% of the patients and had an average size of 2.0 mm in the central part of the liver and 1.8 mm in the peripheral part of the liver. Ducts were seen in the right lobe more often than in the left lobe. There was no statistically significant relationship between visualization of IHBDs and patient age. Demonstration of IHBDs on current CT scanners is a normal finding and does not indicate biliary obstruction.     

Computed tomography of localized dilatation of the intrahepatic bile ducts

Twenty-nine patients showed localized dilatation of the intrahepatic bile ducts on computed tomography, usually unaccompanied by jaundice. Congenital dilatation was diagnosed when associated with a choledochal cyst, while cholangiographic contrast material was helpful in differentiating such dilatation from a simple cyst cy showing its communication with the biliary tract when no choledochal cyst was present. Obstructive dilatation was associated with intrahepatic calculi in 4 cases, hepatoma in 9, cholangioma in 5, metastatic tumor in 5, and polycystic disease in 2. Cholangioma and intrahepatic calculi had a greater tendency to accompany such localized dilatation; in 2 cases, the dilatation was the only clue to the underlying disorder.     

Percutaneous biliary drainage in patients with nondilated intrahepatic bile ducts

OBJECTIVE: We evaluated the technical success and complications of percutaneous transhepatic biliary drainage in patients with nondilated intrahepatic bile ducts. MATERIALS AND METHODS: Between January 1, 1996, and August 31, 1998, 130 percutaneous transhepatic biliary drainage procedures were performed on patients with nondilated intrahepatic bile ducts. This group comprised primarily patients who had received liver transplants or who had sustained iatrogenic bile duct injuries. Access in all procedures was performed using a one-step system consisting of a 21-gauge needle and an .018-inch guidewire. The technical success and complications of the procedures were evaluated. RESULTS: Percutaneous biliary drainage was successful in 117 (90%) of 130 attempts. In four patients, two attempts were required to place a drainage catheter. The overall complication rate was 9%. There were seven (5%) minor complications and five major complications (4%). No procedure-related deaths occurred. CONCLUSION: Percutaneous biliary drainage can be performed with a high success rate in patients with nondilated intrahepatic ducts. The incidence and types of complications in this population were similar to those reported in patients with intrahepatic ductal dilatation.     

Etiologic significance of anatomic variations in the main intrahepatic bile ducts in hepatolithiasis

Abnormal union of intrahepatic bile ducts has been suggested as a possible etiologic factor in the occurrence of intrahepatic stones. A series of 241 patients were examined by direct cholangiography, and anatomic variations in the intrahepatic bile ducts were classified into four types: Type A-1, normal union having a true right hepatic duct; Type A-2, absence of a right hepatic duct, with a trifurcation; Type B, posterior segmental duct draining into left hepatic duct; Type C, anterior segmental duct draining into left hepatic duct. The most dominant type was Type A-1, which occurred in 58.3 to 66.0 per cent of the cases, followed by Type A-2 with 12.5 to 19.8 per cent. Type B showed the lowest incidence, occurring in 4.5 to 10.4 per cent. No statistical difference existed in the distribution of the type of union of intrahepatic bile ducts on the one hand and the presence or absence of intrahepatic stones on the other. Thus, anatomic variations in the main intrahepatic bile ducts do not seem to be associated with hepatolithiasis, and their etiologic significance seems to be unlikely.     

Malignant papillary neoplasms of the intrahepatic bile ducts: CT and histopathologic features

OBJECTIVE. We describe the CT and pathologic features of malignant papillary neoplasms of the intrahepatic bile ducts in 15 patients. CONCLUSION. CT is a useful technique for revealing intraductal lesions, although the findings are nonspecific and variable. When intraductal masses or nodules are seen with localized dilatation of the intrahepatic bile ducts on CT scans, malignant papillary neoplasms of the intrahepatic bile ducts should be included in the differential diagnosis.     

The stilette sign: the appearance of dilated bile ducts in the fatty liver

The appearances of hepatic steatosis and of dilated intrahepatic bile ducts occurring independently are well described. When both conditions occur simultaneously a major sign of biliary obstruction, a double lumen with echogenic walls (the double-barrelled shotgun sign), is modified by the abnormally echogenic liver. The combined appearance is of a tubular structure with no echogenic interface with the liver, containing an echogenic structure at its centre representing echoes from the adjacent bile duct and portal vein walls. We have named this appearance the 'stilette' sign because of its resemblance to a fine needle within a tube. Its importance lies in the fact that it makes dilated intrahepatic bile ducts difficult to recognise by ultrasound.     

CT of hepatoma. Dilatation of the intrahepatic bile ducts and intraductal tumour growth

Computed tomography revealed dilatation of the intrahepatic bile ducts in 25 out of 135 cases of hepatocellular carcinoma. In 6 (4.5%) of these 25 cases the dilatation was generalised, while in the remaining 19 cases (14%) dilatation was localised. In each group 3 cases of intraductal tumour growth was confirmed either at operation or autopsy. With metastatic liver tumour, generalised dilatation was observed in 6 cases (7%) and localised dilatation in 3 (3.5%) out of 85 cases. Localised dilatation was found with higher incidence in hepatocellular carcinoma than in metastatic tumour. This may indicate that the incidence of intraductal infiltration is high in cases of hepatocellular carcinoma. When a relatively small tumour is associated with dilatation of bile ducts, it is more probable that the tumour is a hepatocellular carcinoma than a hepatic metastasis.     

Carcinoid tumor of the extrahepatic bile ducts: Sonographic,cholangiographic, and MDCT features

Carcinoid tumors of the biliary tree are exceedingly rare. To the best of our knowledge, this is the fourth reported case of a biliary carcinoid in the radiological literature. We herein report on a 50-year-old female with a history of breast cancer who presented with epigastric pain. Laboratory evaluation revealed results consistent with obstructive jaundice. Right upper quadrant ultrasound and multidetector-row CT scan showed an intraductal and well-defined tumor in the porta hepatis with dilated intrahepatic bile ducts. Endoscopic retrograde cholangiography showed the intraluminal growth of the tumor was arising from the right hepatic duct. Familiarity with the imaging appearances may prompt early recognition of biliary carcinoids and allow differentiation from other more common biliary neoplasms.     

Dilatation of the intrahepatic bile ducts associated with benign liver lesions: an unusual finding

In three patients presenting different types of liver lesions, including isolated cyst, focal nodular hyperplasia (FNH), and hemangioma, intrahepatic bile duct dilatation was observed on US and CT. Final diagnosis was obtained by surgery in two cases (cyst and FNH) and by 1-year follow-up in one patient presenting an isolated hemangioma. The only common characteristic in our three cases was that lesions were present in segment four according to Couinaud's classification, at the level of the transverse fissure, suggesting that a space-occupying lesion at this site may cause compression of the common hepatic duct and right or left intrahepatic bile ducts. Our report indicates that compression may occur even with lesion of moderate size (35–40 mm in diameter). A benign liver lesion may cause a bile duct dilatation, particularly if located in segment 4, close to the hilum. Awareness of this possibility is important to avoid unnecessary invasive diagnostic procedures, particularly when all imaging criteria are consistent with a benign lesion. Electronic Publication