The biliary tract

Interventional procedures

 

The biliary ducts may be approached in a number of ways; retrogradely through the papilla of Vater, antegradely by means of percutaneous transhepatic puncture or through the gallbladder.

A sphincterotomy or papillotomy may be performed through an endoscope, and this facilitates the passage of gallstones from the extrahepatic ducts into the duodenum; the technique can be used in poor-risk patients.

Figure 39. Cholecystostomy. A drainage tube has been introduced percutaneously into the gallbladder. The draining catheter has slipped out of the gallbladder and its tip now lodges in a fistula from the gallbladder to the skin.

The transhepatic approach allows the institution of either external or internal biliary drainage and can also be used for the percutaneous introduction of instruments for the dilatation of stenosed biliary ducts. The same treatment may also be performed via the endoscopic route (Fig. 38).
The gallbladder can be percutaneously punctured and drained through a catheter, a technique that is particularly suitable in those cases of acute cholecystitis where surgery is thought to be inappropriate (Fig. 39).

 

David J. Allison and Carl-Gustaf Standertskjold-Nordenstam