Percutaneous Transhepatic Cholangiography and Biliary Drainage in Pediatric Liver Transplant Patients

Size: px
Start display at page:

Download "Percutaneous Transhepatic Cholangiography and Biliary Drainage in Pediatric Liver Transplant Patients"

Transcription

1 Jonathan M. Lorenz 1 Brian Funaki Jeffrey A. Leef Jordan D. Rosenblum Thuong Van Ha Received June 27, 2000; accepted after revision August 16, All authors: Department of Radiology, The University of Chicago Hospitals, 5841 S. Maryland Ave., MC 2026, Chicago, IL Address correspondence to J. M. Lorenz. AJR 2001;176: X/01/ American Roentgen Ray Society Percutaneous Transhepatic Cholangiography and Biliary Drainage in Pediatric Liver Transplant Patients OBJECTIVE. In children with liver transplants, percutaneous transhepatic cholangiography has a critical role in evaluation and treatment of biliary complications. The purpose of this study was to evaluate the technical success and complication rates of percutaneous transhepatic cholangiography and biliary drain placement in children who underwent liver transplantation. MATERIALS AND METHODS. Between January 1, 1995 and July 1, 1999, 120 pediatric percutaneous transhepatic cholangiography procedures were performed in 76 patients (34 boys, 42 girls; age range, 5 months to 18 years; mean age, 5.3 years). Patients had received left lateral segment, whole-liver, or split-liver transplant grafts. Retrospective review of all pertinent radiology studies and electronic chart review were performed. RESULTS. A diagnostic cholangiogram was obtained in 96% (115/120) of all procedures and drainage catheter placement was successful in 89% (88/99) of attempts. In patients with nondilated intrahepatic bile ducts, a diagnostic cholangiogram was obtained in 92% (46/50) of procedures, and drainage catheter placement was successful in 76% (19/25) of attempts. Minor complications occurred in 10.8% (13/120) of procedures and included transient hemobilia with mild drop in hematocrit level (n = 2), mild pancreatitis (n = 1), fever with bacteremia (n = 5), and fever with negative blood cultures (n = 5). Major complications occurred in 1.7% (2/120) of procedures and included sepsis (n = 1) and hemoperitoneum requiring immediate surgery (n = 1). CONCLUSION. Percutaneous transhepatic cholangiography and biliary drainage can be performed with high technical success and low complication rates in pediatric liver transplant patients, even in those with nondilated intrahepatic ducts. L iver transplantation has become a common treatment for children with acquired and congenital liver diseases. In patients with biliary complications of liver transplantation, imaging studies may be misleading because the intrahepatic bile ducts are often nondilated, even when obstructed [1, 2]. Because liver transplants in children are commonly performed using a Roux-en-Y biliary enteric anastomosis, endoscopic retrograde cholangiopancreatography is not technically possible. Therefore, percutaneous transhepatic cholangiography (PTC) has a critical role in evaluation and treatment of patients with suspected biliary disease. PTC and biliary drainage are technically challenging in children who have undergone liver transplantation because of the small caliber of the intrahepatic biliary tree. Although guidelines for success and complication rates of PTC in adult patients have recently been reported [3, 4], no large studies have addressed these parameters in children. The purpose of this retrospective study was to establish the technical success and complication rates of PTC and biliary drain placement in children who have undergone liver transplantation. Materials and Methods Between January 1, 1995 and July 1, 1999, 120 pediatric PTC procedures were performed in 76 patients (34 boys, 42 girls; age range, 5 months to 18 years; mean age, 5.3 years). A retrospective review of all cases was performed to evaluate technical success and complication rates. All pertinent radiology reports and cholangiographic and sonographic images were reviewed. Electronic chart review was performed for all patients, including operative notes, discharge reports, pathology reports, cultures, and laboratory data. The presence or absence of bile duct dilatation was shown on sonography before PTC and confirmed in all successful procedures at cholangiography. On sonography, bile duct dilatation was defined as identification of peripheral ducts that were larger than the adjacent portal vein. Intrahepatic bile duct dilatation was present in 58% (70/120) of procedures and absent in 42% (50/120) of procedures. AJR:176, March

2 Left lateral segment, whole-liver, and split-liver left-lobe transplant grafts were included in the study. A summary of the number of patients and procedures for each type of liver transplant graft is provided in Table 1. In patients with left lateral segment grafts, drainage of the donor Couinaud segments II and III TABLE 1 Type of Graft Type of Graft, Number of Patients, and PTC Procedures in 76 Children with Liver Transplants Procedures Patients a Left lateral segment Whole liver Left lobe, split liver 2 2 Note. PTC = percutaneous transhepatic cholangiography. a Two patients were included in both left lateral segment and whole-liver groups due to retransplantation during course of study. A A Lorenz et al. ducts occurs across a single Roux-en-Y cholangiojejunostomy. In patients with whole-liver transplant grafts, biliary drainage occurs across a choledochojejunostomy or a choledochocholedochostomy. In patients with split-liver left-lobe grafts, the entire left lobe of the donor graft is used TABLE 2 Indications and Number of PTC Procedures in 76 Patients with Liver Transplants Indication Procedures Elevated liver enzyme levels a 86 Fever 12 Sepsis 9 Bile leak 9 Accidental catheter removal 3 T-tube obstruction 1 Note. PTC = percutaneous transhepatic cholangiography. a Elevation of serum bilirubin, alkaline phosphatase, and γ-glutamyl transpeptidase levels without fever or sepsis. B and biliary drainage occurs across a Roux-en-Y cholangiojejunostomy. Two patients were included in both the left lateral segment and the whole-liver transplant groups as a result of retransplantation during the course of the study. Indications for PTC are summarized in Table 2. Procedure B Fig year-old girl with left lateral segment transplant graft and elevated liver enzyme levels. A, Cholangiogram shows that access to two different bile ducts was required before successful cannulation was achieved. Despite presence of nondilated ducts, biliary enteric stricture (arrow) is present. B, Internal external 6-French drainage catheter was placed via segment III bile duct. Fig year-old boy with whole-liver transplant graft and elevated liver enzyme levels. A, Cholangiogram shows that biliary access was achieved via nondilated right-sided bile duct. Leftsided intrahepatic bile ducts are moderately dilated. B, Cholangiogram shows that drainage catheter was subsequently placed. Before all procedures, patients with a prothrombin time greater than 17 sec or platelet count less than 50,000/mm 3 received blood products to correct deficiencies. All patients received broad-spectrum antibiotics before the procedure. The procedures were all performed under general anesthesia, and additional subcutaneous 1% lidocaine was administered as local anesthesia. Punctures into the liver were made with a 21-gauge needle (Accustick II Introducer System, Boston Scientific, Natick, MA; or Micropuncture System, Cook, Bloomington, IN). Lateral punctures into the right lobe of the liver were performed preferentially in patients with whole-liver grafts. An oblique subcostal or subxyphoid approach was preferentially used in patients with left lateral segment grafts. In 762 AJR:176, March 2001

3 Percutaneous Transhepatic Cholangiography and Biliary Drainage 46 procedures, sonographic guidance was used in addition to fluoroscopic guidance to guide needle placement. Our technique for sonographically guided PTC involved using a 7-MHz transducer to visualize and access the duct along a longitudinal rather than a transverse plane. This orientation allowed real-time visualization of the needle along its entire course while maintaining longitudinal visualization of the bile duct. To prevent infiltrated air from obscuring future attempts using sonography, test contrast material was not injected unless dimpling or deflection of the target duct was verified sonographically during needle advancement. Dilute contrast material was gently infiltrated while retracting the needle until a peripheral bile duct was opacified (Figs. 1A and 2A). If a more central duct was entered, a second needle was used to puncture a more peripheral duct after opacifying the intrahepatic bile ducts. If no ducts were opacified on the initial puncture, the needle was withdrawn to a subcapsular position, redirected, and advanced again. If no ducts were opacified after five passes, the needle was completely removed, and a second puncture was made adjacent to the first puncture site. Although the exact number of needle passes was not recorded in each case, the procedure was usually terminated after approximately 25 needle passes, or after reaching the patient s pediatric contrast dose limit (4 ml/kg). If the biliary enteric anastomosis was widely patent and no strictures were observed in the biliary tree, no biliary drain was placed. If a drainage catheter was required, an inch guidewire with a hydrophilic tip (V18 Control Wire; Boston Scientific) was used for duct cannulation in all cases. A standard inch guidewire was then advanced through the Accustick or Micropuncture coaxial dilator into the small bowel. If necessary, an end-hole catheter was used to direct the guidewire through bile duct stenoses into the small bowel. The inch wire was exchanged for a stiff inch guidewire through a 5-French endhole catheter. The tract was dilated to accept a biliary drainage catheter (Ultrathane Biliary Drainage Catheter; Cook) ranging in size from 6- to 10-French, which was left to external gravity drainage (Figs. 1B and 2B). Most patients were inpatients; however, all outpatients were admitted overnight for observation after the procedure. The Society of Cardiovascular and Interventional Radiology guidelines regarding major and minor complications were used [3]. Fig. 3. Flow diagram shows attempts, successes, and failures of PTC and biliary drainage. Results Percutaneous Transhepatic Cholangiography Bile duct opacification was successful in 96% (115/120) of all procedures. In the five cases of failed opacification, two procedures involved left lateral segment grafts and three procedures involved whole-liver grafts. In diagnostic cholangiograms in patients with left lateral segment grafts and left lobe split liver grafts, duct opacification was achieved by accessing the segment II duct in 34% (23/68) of procedures and the segment III duct in 66% (45/ 68) of procedures. In diagnostic cholangiograms in patients with whole-liver grafts, duct opacification was achieved via the right lobe in 83% (39/47) and the left lobe in 17% (8/47). The technical success rate was 94% (47/50) for whole-liver grafts and 96% (65/68) for left lateral segment grafts. Figure 3 shows attempts, successes, and failures of PTC. Biliary Drainage In 21 of the 115 procedures in which diagnostic cholangiograms were obtained, drainage catheter placement was not indicated on the basis of the findings of the cholangiogram. Drainage catheter placement was successful in 94% (88/94) of the remaining procedures. In the six procedures resulting in failed duct cannulation, three procedures were performed in patients with left lateral segment transplant grafts, and three procedures were performed in patients with whole-liver transplant grafts. On an intentto-treat basis, there were 11 failed attempts at drainage catheter placement in 99 procedures, resulting in a technical success rate of 89% (88/ 99). The 11 failed attempts at drainage catheter placement include the five failed attempts at duct opacification described previously for PTC and the six failed attempts at duct cannulation. Eleven patients required two catheters because of multiple strictures. Figure 3 shows attempts, successes, and failures of biliary drainage. Nondilated Ducts In patients with nondilated intrahepatic bile ducts, diagnostic cholangiograms were obtained in 92% (46/50) of procedures. In four procedures, we were unable to opacify the biliary ducts because of technical difficulties, and no further procedures were attempted. In 50% (25/ 50) of procedures, drainage catheter placement was not attempted on the basis of the appearance of the cholangiogram and the clinical information. Drainage catheter placement was successful in 76% (19/25) of the remaining procedures. In the six failed attempts, duct opacification was unsuccessful in four procedures, and duct cannulation (after successful duct opacifi- AJR:176, March

4 Lorenz et al. TABLE 3 Technical Success and Complication Rates of Procedures in Patients with Nondilated Versus Dilated Intrahepatic Bile Ducts Procedure Note. Rate = no. of procedures/total no. of procedures. NA = not available. a Twenty-five of the 50 percutaneous transhepatic cholangiography procedures on nondilated ducts did not progress to biliary drainage. b All procedures on dilated ducts progressed to biliary drainage. cation) was unsuccessful in two procedures. In the two latter cases of failed duct cannulation, a second procedure was successful. Table 3 shows technical success rates for PTC and biliary drainage in procedures involving nondilated versus dilated ducts. Technical Successes Complications Nondilated Dilated Nondilated Dilated % No. % No. % No. % No. Percutaneous transhepatic cholangiography 92 46/ /70 8 2/25 a NA NA b Drain placement 76 19/ / / /70 Complications Complications occurred in 12.5% (15/120) of procedures. Complications occurred in 8% (2/25) of the PTC procedures that did not progress to biliary drainage and 14% (13/95) of the procedures that progressed to biliary drainage. Table 3 shows complication rates for PTC and biliary drainage in procedures involving nondilated versus dilated ducts. Minor complications occurred in 10.8% (13/120) of procedures and included transient hemobilia with mild drop in hematocrit level (n = 2), mild pancreatitis (n = 1), fever with bacteremia (n = 5), and fever with negative blood cultures (n = 5). Major complications occurred in 1.7% (2/120) of procedures and included sepsis (n = 1) and hemoperitoneum requiring immediate surgery (n = 1). The two major complications occurred during procedures requiring biliary drainage. The single major bleeding complication occurred in a 2- year-old girl with a left lateral segment transplant graft 2 days after liver transplantation. After eight punctures, the patient experienced an acute drop in blood pressure, and abdominal distention was observed. Active bleeding from the cut edge of the liver was noted at the time of emergent exploratory laparotomy. In the six patients with sepsis (n = 1) and transient bacteremia (n = 5), blood cultures grew Xanthomonas maltophilia, Pseudomonas aeruginosa, Corynebacterium species, Escherichia coli, vancomycin-resistant Enterococcus organisms, and coagulase-negative Staphylococcus organisms. All patients were treated with antibiotics and had uneventful recoveries. In the single case of mild pancreatitis, a 17-year-old boy with a whole-liver graft complained of abdominal tenderness after the procedure, and mild elevations of amylase and lipase levels were observed. The patient had an uneventful recovery in 1 week, after a course of medical therapy. The 30-day mortality rate was 2.5% (3/ 120). All three patients who died were liver transplant recipients who had had severe underlying problems before PTC, including sepsis, renal failure, severe acute rejection, and graft-versus-host disease. None of the deaths were directly attributable to PTC. Discussion Liver transplantation is now a standard treatment for children with congenital liver disease. Unfortunately, biliary complications may occur in 13% to 30% of patients [5 8]. The clinical evaluation of biliary complications is difficult because patients often present with nonspecific signs and symptoms. In addition, the imaging findings of biliary complications may be misleading because intrahepatic duct dilatation is frequently absent even in cases of obstruction [1, 2, 6]. In most of the liver transplants performed in our pediatric population, a Roux-en-Y biliary enteric anastomosis is created; therefore, endoscopic retrograde cholangiopancreatography is not technically possible. Because of the limitations of other imaging modalities and of the clinical evaluation, PTC and biliary drainage are often necessary for diagnosis and treatment. To our knowledge, there are no large published series addressing technical success and complication rates of pediatric PTC and biliary drainage. The most common biliary complications of pediatric liver transplantation are strictures and bile leaks, and placement of a biliary drainage catheter is usually the initial treatment. Biliary strictures may occur at the surgical anastomosis (Fig. 1A) or elsewhere in the biliary tree due to infectious, immunologic, or ischemic causes. Bile leaks usually occur in the first few weeks after transplantation, either at the surgical anastomosis, the roux limb, or the cut edge of a reduced-size graft [7]. In published adult series, percutaneous treatment of strictures and bile leaks often produces lasting results [9], but in pediatric series, eventual operative repair is required in most cases [5, 10]. Other biliary complications include intraparechymal biloma, choledocholithiasis, and cholangitis. Our experience indicates that technical success rates of PTC and biliary drainage in children are similar to those in adults. In children with dilated ducts, our success rates for diagnostic cholangiography and drain placement were 100% and 93%, respectively, as compared with % in published adult series [11, 12]. In children with nondilated ducts, our success rates for diagnostic cholangiography and drain placement were 92% and 76%, respectively, as compared with 90% and 86% in a recent published adult series [4]. Our results for pediatric patients are well within Society of Cardiovascular and Interventional Radiology guidelines [3] for thresholds of technical success in adult patients with nondilated ducts (65% and 46% for diagnostic cholangiography and drain placement, respectively). We attribute our high technical success rates in part to our frequent use of direct sonographically guided needle puncture in pediatric patients. We have found that direct sonographic guidance of pediatric PTC markedly reduces the number of needle passes and contrast media dose required, and results in a high technical success rate. Using fluoroscopy alone without direct sonographic guidance, technical success rates are proportional to the number of needle passes [13], and multiple passes are often required in children. Limits of contrast media dose may be reached rapidly in small infants using this fluoroscopic approach. Ischemic or immunologic injury to the bile ducts can result in smaller ducts, which are reduced in number [14], further increasing the number of needle passes required for PTC. Our high technical success rate in duct cannulation is largely attributable to the use of a inch wire with a stiff shaft and a hydrophilic tip. We find that the tip of this wire can be shaped easily with a short 90 angulation, which facilitates duct cannulation, even in cases involving nondilated bile ducts. The stiff shaft of this wire allows easy advancement of the Accustick or Micropuncture coaxial dilator through dense, fibrotic liver tissue. Although, to our knowledge, no pediatric guidelines for complication rates of PTC and biliary drainage have been published, our results are within the major complication 764 AJR:176, March 2001

5 Percutaneous Transhepatic Cholangiography and Biliary Drainage threshold of 10% recommended by the Society of Cardiovascular and Interventional Radiology [3] for adult procedures. The types of complications in our series are similar to most published adult series [15, 16] and include peritoneal bleeding, sepsis, hemobilia, fever, and pancreatitis. Some patients who have undergone liver transplantation may be more susceptible to bleeding complications of PTC. The major bleeding complication in our series occurred in a patient who had recently received a liver transplant. The risk of peritoneal hemorrhage in patients shortly after transplant may be increased due to the absence of a protective fibrous capsule around the transplantation graft. Color Doppler sonography may allow the operator to avoid puncturing major vascular structures while accessing a bile duct, which may result in fewer complications [17, 18]. Hemobilia, sepsis, and transient bacteremia may occur after traversal of vascular structures as a result of biliary venous communication. The biliary catheter can serve as a biliary vascular fistula if side holes are present in both the portal vein and biliary tree. The cases of a mild drop in hematocrit level with hemobilia in our series resolved after repositioning the catheter with all side holes advanced into the biliary tree. Bacteremia can result from a malpositioned drainage catheter causing fistula or obstruction, or from overdistention of an obstructed biliary tree during the cholangiogram causing reflux of bacteria-laden bile into the bloodstream. Despite the use of preprocedural broad-spectrum antibiotics, cases of procedure-related fever, bacteremia, and sepsis occurred; however, all patients responded to treatment with antibiotics. Pancreatitis, which is a known complication of PTC, occurred in one patient in our series. Pancreatitis can result from either direct puncture and overdistention of the pancreatic duct or obstruction of the pancreatic duct by the biliary drainage catheter. In conclusion, we found that PTC and biliary drainage can be performed with high technical success and low complication rates in pediatric patients who have undergone liver transplantation. Although a relatively large number of passes may be required to opacify a bile duct suitable for catheter placement when duct dilatation is absent, we achieved high technical success rates in patients with nondilated ducts. The types and incidences of complications in our series were similar to those seen in published adult series. References 1. Zajko AB, Zemel G, Skolnick ML, et al. Percutaneous transhepatic cholangiography rather than ultrasound as a screening test for postoperative biliary complications in liver transplant patients. Transplant Proc 1988;20: Zemel G, Zajko AB, Skolnick ML, Bron KM, Campbell WL. The role of sonography and transhepatic cholangiography in the diagnosis of biliary complications after liver transplantation. AJR 1988;151: Burke DR, Lewis CA, Cardella JF, et al. Quality improvement guidelines for percutaneous transhepatic cholangiography and biliary drainage. J Vasc Interv Radiol 1997;8: Funaki B, Zaleski GX, Straus CA, et al. Percutaneous biliary drainage in patients with nondilated intrahepatic ducts. AJR 1999;173: Chardot C, Candinas D, Mirza D, et al. Biliary complications after pediatric liver transplantation: Birmingham s experience. Transpl Int 1995;8: Griffith JF, John PR. Imaging of biliary complications following pediatric liver transplantation. Pediatr Radiol 1996;26: Heffron TG, Emond JC, Whitington PF, et al. Biliary complications in pediatric liver transplantation: a comparison of reduced-size and whole grafts. Transplantation 1992;53: Lallier M, St-Vil D, Luks FI, et al. Biliary tract complications in pediatric orthotopic liver transplantation. J Pediatr Surg 1993;28: Lopez RR, Benner KG, Ivancev K, Keeffe EB, Deveney CW, Pinson CW. Management of biliary complications after liver transplantation. Am J Surg 1992; 163: Peclet MH, Ryckman FC, Pedersen SH, et al. The spectrum of bile duct complications in pediatric liver transplantation. J Pediatr Surg 1994;29: Brailski KH, Chernev K, Pomakov P, Bozhianov V. Percutaneous transhepatic cholangiography with an ultra-fine needle (Chiba) in the diagnosis and differential diagnosis of cholestasis [in Bulgarian]. Vutr Boles 1982;21: Schoenemann J, Geisthovel W, Laum J. Percutaneous transhepatic cholangiography with the skinny needle technique and external biliary drainage [in German]. Z Gastroenterol 1981;19: Harbin WP, Mueller PR, Ferrucci JT Jr. Transhepatic cholangiography: complications and use patterns of the fine-needle technique a multi-institutional survey. Radiology 1980;135: Oguma S, Belle S, Starzl TE, Demetris AJ. A histometric analysis of chronically rejected human liver allografts: insights into the mechanisms of bile duct loss direct immunologic and ischemic factors. Hepatology 1989;9: Hamlin JA, Friedman M, Stein MG, Bray JF. Percutaneous biliary drainage: complications of 118 consecutive catheterizations. Radiology 1986;158: Nilsson U, Evander A, Ihse I, Lunderquist A, Mocibob A. Percutaneous transhepatic cholangiography and drainage: risks and complications. Acta Radiol 1983;24: Koito K, Namieno T, Nagakawa T, Morita K. Percutaneous transhepatic biliary drainage using color Doppler ultrasonography. J Ultrasound Med 1996; 15: Lameris JS, Obertop H, Jeekel J. Biliary drainage by ultrasound-guided puncture of the left hepatic duct. Clin Radiol 1985;36: AJR:176, March

Outcomes and Risk Factors for Failure of Radiologic Treatment of Biliary Strictures in Pediatric Liver Transplantation Recipients

Outcomes and Risk Factors for Failure of Radiologic Treatment of Biliary Strictures in Pediatric Liver Transplantation Recipients LIVER TRANSPLANTATION 12:821-826, 2006 ORIGINAL ARTICLE Outcomes and Risk Factors for Failure of Radiologic Treatment of Biliary Strictures in Pediatric Liver Transplantation Recipients Bhanu Sunku, 1

More information

Vascular complications in percutaneous biliary interventions: A series of 111 procedures

Vascular complications in percutaneous biliary interventions: A series of 111 procedures Vascular complications in percutaneous biliary interventions: A series of 111 procedures Poster No.: C-0744 Congress: ECR 2013 Type: Educational Exhibit Authors: A. BHARADWAZ; AARHUS, Re/DK Keywords: Obstruction

More information

Percutaneous Biliary Drainage in Patients With Nondilated Intrahepatic Bile Ducts Compared With Patients With Dilated Intrahepatic Bile Ducts

Percutaneous Biliary Drainage in Patients With Nondilated Intrahepatic Bile Ducts Compared With Patients With Dilated Intrahepatic Bile Ducts Vascular and Interventional Radiology Original Research Kühn et al. Drainage of Dilated vs Nondilated Intrahepatic Bile Ducts Vascular and Interventional Radiology Original Research FOCUS ON: Jens P. Kühn

More information

Stenoses of Vascular Anastomoses After Hepatic Transplantation: Treatment with Balloon Angioplasty

Stenoses of Vascular Anastomoses After Hepatic Transplantation: Treatment with Balloon Angioplasty 167 Stenoses of Vascular Anastomoses After Hepatic Transplantation: Treatment with Balloon Angioplasty Nigel Raby1 Vascular complications after liver transplantation include occlusion or stenosis at the

More information

Percutaneous biliary drainage: complications and efficiency at short and mean terms: about 50 cases

Percutaneous biliary drainage: complications and efficiency at short and mean terms: about 50 cases Percutaneous biliary drainage: complications and efficiency at short and mean terms: about 50 cases Poster No.: C-1497 Congress: ECR 2016 Type: Scientific Exhibit Authors: M. Matri, L. Ben Farhat, I. Marzouk

More information

Kenneth L. Croutch, * R q L. Gordon, * Ernest J. Ring, * Robert K. Kerlan Jr., * Jeanne M. LclBerge, * andjohn P. Roberts t. Patients and Methods

Kenneth L. Croutch, * R q L. Gordon, * Ernest J. Ring, * Robert K. Kerlan Jr., * Jeanne M. LclBerge, * andjohn P. Roberts t. Patients and Methods Superselective Arterial Embolization in the liver Transplant Recipient: A Safe Treatment for Hemobilia Caused by Percutaneous Transhepatic Biliary Drainage Kenneth L. Croutch, * R q L. Gordon, * Ernest

More information

Single-Step Placement of a Self-Retaining Accordion Catheter

Single-Step Placement of a Self-Retaining Accordion Catheter 337 J. G. Caridi1 I. F. Hawkins, Jr. M. C. Hawkins Received August 1 6, 1982; accepted after revision February 10, 1984. 1 All authors: Department of Radiology (Box J- 374), University of Florida College

More information

Dual Catheter Placement Technique for Treatment of Biliary Anastomotic Strictures After Liver Transplantation

Dual Catheter Placement Technique for Treatment of Biliary Anastomotic Strictures After Liver Transplantation LIVER TRANSPLANTATION 17:159-166, 2011 ORIGINAL ARTICLE Dual Catheter Placement Technique for Treatment of Biliary Anastomotic Strictures After Liver Transplantation Dong Il Gwon, 1 Kyu-Bo Sung, 1 Gi-Young

More information

The role of cholangiography with t-tube in the liver transplantation

The role of cholangiography with t-tube in the liver transplantation The role of cholangiography with t-tube in the liver transplantation Poster No.: C-0362 Congress: ECR 2012 Type: Educational Exhibit Authors: S. Magalhães, I. Ferreira, A. B. Ramos, F. Reis, M. Ribeiro

More information

Jaundice. Agnieszka Dobrowolska- Zachwieja, MD, PhD

Jaundice. Agnieszka Dobrowolska- Zachwieja, MD, PhD Jaundice Agnieszka Dobrowolska- Zachwieja, MD, PhD Jaundice definition Jaundice, as in the French jaune, refers to the yellow discoloration of the skin. It arises from the abnormal accumulation of bilirubin

More information

The role of interventional radiology in complications after paediatric liver transplantation

The role of interventional radiology in complications after paediatric liver transplantation The role of interventional radiology in complications after paediatric liver transplantation J Cantrell, M Ch, FCRad (S) Wits onald Gordon Medical Centre, University of the Witwatersrand, Johannesburg,

More information

MAKING CONNECTIONS. Los Angeles Medical Center

MAKING CONNECTIONS. Los Angeles Medical Center MAKING CONNECTIONS Los Angeles Medical Center Resident: Chris Molloy, MD Fellow: Christian Coroian, MD, MBA Attending: Tina Hardley, MD Program/Dept(s): Los Angeles Medical Center CHIEF COMPLAINT & HPI

More information

Percutaneous biliary drainage catheter insertion in patients with extensive hepatic metastatic tumor burden

Percutaneous biliary drainage catheter insertion in patients with extensive hepatic metastatic tumor burden Original Article Percutaneous biliary drainage catheter insertion in patients with extensive hepatic metastatic tumor burden Eun L. Langman 1, Paul V. Suhocki 1, Herbert I. Hurwitz 2, Michael A. Morse

More information

Spectrum of CT Findings in Pediatric Patients after Partial Liver Transplantation 1

Spectrum of CT Findings in Pediatric Patients after Partial Liver Transplantation 1 EDUCATION EXHIBIT Spectrum of CT Findings in Pediatric Patients after Partial Liver Transplantation 1 53 Fumie Ametani, MD Kyo Itoh, MD Toshiya Shibata, MD Yoji Maetani, MD Koichi Tanaka, MD Junji Konishi,

More information

Gum O Jung and Dong Eun Park. Department of Surgery, Wonkwang University Hospital, Wonkwang University School of Medicine, Iksan, Korea

Gum O Jung and Dong Eun Park. Department of Surgery, Wonkwang University Hospital, Wonkwang University School of Medicine, Iksan, Korea Korean J Hepatobiliary Pancreat Surg 2012;16:110-114 Case Report Successful percutaneous management of bronchobiliary fistula after radiofrequency ablation of metastatic cholangiocarcinoma in a patient

More information

A CASE REPORT OF SPONTANEOUS BILOMA - AN ENIGMATIC SURGICAL PROBLEM

A CASE REPORT OF SPONTANEOUS BILOMA - AN ENIGMATIC SURGICAL PROBLEM A CASE REPORT OF SPONTANEOUS BILOMA - AN ENIGMATIC SURGICAL PROBLEM *Sumanta Kumar Ghosh and Biswajit Mukherjee ESIC Medical College, Joka, Kolkata, India *Author for Correspondence ABSTRACT Occurrence

More information

Post-operative complications following hepatobiliary surgery: imaging findings and current radiological treatment options

Post-operative complications following hepatobiliary surgery: imaging findings and current radiological treatment options Post-operative complications following hepatobiliary surgery: imaging findings and current radiological treatment options Poster No.: C-1501 Congress: ECR 2015 Type: Educational Exhibit Authors: A. Hadjivassiliou,

More information

RadRx Your Prescription for Accurate Coding & Reimbursement Copyright All Rights Reserved.

RadRx Your Prescription for Accurate Coding & Reimbursement Copyright All Rights Reserved. Interventional Radiology Coding Case Studies Prepared by Stacie L. Buck, RHIA, CCS-P, RCC, CIRCC, AAPC Fellow President & Senior Consultant Week of October 22, 2018 Paracentesis & Transjugular Liver Biopsy

More information

Original Policy Date 12:2013

Original Policy Date 12:2013 MP 6.01.30 Magnetic Resonance Cholangiopancreatography Medical Policy Section Radiology Is12:2013sue 3:2005 Original Policy Date 12:2013 Last Review Status/Date 12:2013 Return to Medical Policy Index Disclaimer

More information

Interventional Radiology Rounds:

Interventional Radiology Rounds: 1295 Interventional Radiology Rounds: University of California, San Francisco Percutaneous Biliary Drainage in the Management of Cholangiocarcinoma Robert K. Kerlan, Jr., Moderator1 Anton C. Pogany2 Henry

More information

Interventional radiology

Interventional radiology Interventional radiology Nonvascular Doros Attila MD, Semmelweis Univ. Dept.of Transplantation and Surgery Radiology med IR/MIT Attempted non surgical invasive therapy with good results (sometimes as good

More information

The authors have declared no conflicts of interest.

The authors have declared no conflicts of interest. Diagnostic Accuracy of Magnetic Resonance Cholangiopancreatography Versus Endoscopic Retrograde Cholangiopancreatography Findings in the Postorthotopic Liver Transplant Population Authors: *Ashok Shiani,

More information

BILIARY TRACT COMPLICATIONS IN HUMAN ORTHOTOPIC LIVER TRANSPLANTATION 1,2

BILIARY TRACT COMPLICATIONS IN HUMAN ORTHOTOPIC LIVER TRANSPLANTATION 1,2 004-33/8/430-004$02.00/0 TRANSPLANTATION Copyright (c) 98 by The Williams & Wilkins Co. Vol. 43, No. Printed in U.S.A. BILIARY TRACT COMPLICATIONS IN HUMAN ORTHOTOPIC LIVER TRANSPLANTATION,2 JAN LERUT,

More information

The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (9), Page

The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (9), Page The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (9), Page 5153-5160 Role of Interventional Radiology in the Management of Postoperative Biliary Complications 1 Hana Hamdy Nasif, 1 Mennatallah

More information

Role of magnetic resonance cholangiography (MRC) in the detection of biliary complications after orthotopic liver transplantation (OLT)

Role of magnetic resonance cholangiography (MRC) in the detection of biliary complications after orthotopic liver transplantation (OLT) Role of magnetic resonance cholangiography (MRC) in the detection of biliary complications after orthotopic liver transplantation (OLT) Poster No.: B-227 Congress: ECR 2010 Type: Topic: Scientific Paper

More information

Research Article Safety and Yield of Diagnostic ERCP in Liver Transplant Patients with Abnormal Liver Function Tests

Research Article Safety and Yield of Diagnostic ERCP in Liver Transplant Patients with Abnormal Liver Function Tests Diagnostic and erapeutic Endoscopy, Article ID 314927, 5 pages http://dx.doi.org/10.1155/2014/314927 Research Article Safety and Yield of Diagnostic ERCP in Liver Transplant Patients with Abnormal Liver

More information

Bronchobiliary fistula treated with histoacryl embolization under bronchoscopic guidance: A case report

Bronchobiliary fistula treated with histoacryl embolization under bronchoscopic guidance: A case report Respiratory Medicine CME (2008) 1, 164 168 respiratory MEDICINE CME CASE REPORT Bronchobiliary fistula treated with histoacryl embolization under bronchoscopic guidance: A case report Jung Hyun Kim a,

More information

Management of Gallbladder Disease

Management of Gallbladder Disease Management of Gallbladder Disease Steven B. Johnson, MD, FACS, FCCM Professor and Chairman, Department of Surgery Program Director, Phoenix Integrated Surgical Residency University of Arizona College of

More information

Imaging of liver and pancreas

Imaging of liver and pancreas Imaging of liver and pancreas.. Disease of the liver Focal liver disease Diffusion liver disease Focal liver disease Benign Cyst Abscess Hemangioma FNH Hepatic adenoma HCC Malignant Fibrolamellar carcinoma

More information

Interventional Radiology Rounds:

Interventional Radiology Rounds: 145 Interventional Radiology Rounds: University of California, San Francisco Radiologic Management of Abdominal Abscesses Robert K. Kerlan, Jr., Moderator1 Anton C. Pogany2 R. Brooke Jeffrey3 Henry I.

More information

Results of Choledochojejunostomy in the Treatment of Biliary Complications After Liver Transplantation in the Era of Nonsurgical Therapies

Results of Choledochojejunostomy in the Treatment of Biliary Complications After Liver Transplantation in the Era of Nonsurgical Therapies Results of Choledochojejunostomy in the Treatment of Biliary Complications After Liver Transplantation in the Era of Nonsurgical Therapies Brian R. Davidson, Rakesh Rai, Ashim Nandy, Nilesh Doctor, Andrew

More information

ACUTE CHOLANGITIS AS a result of an occluded

ACUTE CHOLANGITIS AS a result of an occluded Digestive Endoscopy 2017; 29 (Suppl. 2): 88 93 doi: 10.1111/den.12836 Current status of biliary drainage strategy for acute cholangitis Endoscopic treatment for acute cholangitis with common bile duct

More information

Percutaneous Transhepatic Stent Placement in the Management of Portal Venous Stenosis After Curative Surgery for Pancreatic and Biliary Neoplasms

Percutaneous Transhepatic Stent Placement in the Management of Portal Venous Stenosis After Curative Surgery for Pancreatic and Biliary Neoplasms Vascular and Interventional Radiology Original Research Kim et al. Transhepatic Stent Placement for Postsurgical Stenosis Vascular and Interventional Radiology Original Research Kyung Rae Kim 1 Gi-Young

More information

Surgical Management of CBD Injury Jin Seok Heo

Surgical Management of CBD Injury Jin Seok Heo Surgical Management of CBD Injury Jin Seok Heo Department of Surgery, Samsung Medical Center Sungkyunkwan University School of Medicine, Seoul, Republic of Korea Bile duct injury (BDI) Introduction Incidence

More information

Cholangiocarcinoma (Bile Duct Cancer)

Cholangiocarcinoma (Bile Duct Cancer) Cholangiocarcinoma (Bile Duct Cancer) The Bile Duct System (Biliary Tract) A network of bile ducts (tubes) connects the liver and the gallbladder to the small intestine. This network begins in the liver

More information

Liver Transplantation in Children: Techniques and What the Surgeon Wants to Know from Imaging

Liver Transplantation in Children: Techniques and What the Surgeon Wants to Know from Imaging Liver Transplantation in Children: Techniques and What the Surgeon Wants to Know from Imaging Jaimie D. Nathan, MD Associate Professor of Surgery and Pediatrics Associate Surgical Director, Liver Transplant

More information

Liver Biopsy Related Infection in Liver Transplant Recipients: A Current Matter of Concern?

Liver Biopsy Related Infection in Liver Transplant Recipients: A Current Matter of Concern? LIVER TRANSPLANTATION 20:552 556, 2014 ORIGINAL ARTICLE Liver Biopsy Related Infection in Liver Transplant Recipients: A Current Matter of Concern? Cristina Lopez Sanchez, 1 Oscar Len, 1 Joan Gavalda,

More information

Abdominal Imaging. Gallbladder perforation: color Doppler findings

Abdominal Imaging. Gallbladder perforation: color Doppler findings Abdom Imaging 27:47 50 (2002) DOI: 10.1007/s00261-001-0048-1 Abdominal Imaging Springer-Verlag New York Inc. 2002 Gallbladder perforation: color Doppler findings K. Konno, 1 H. Ishida, 1 M. Sato, 1 H.

More information

Hepatic Sepsis: Generally Applicable Lessons Learned from Liver Transplantation

Hepatic Sepsis: Generally Applicable Lessons Learned from Liver Transplantation Hepatic Sepsis: Generally Applicable Lessons Learned from Liver Transplantation i" rr=z?%7a n. Thomas E. Stanl, M.D., Ph.D. and Charles W. Putnam, M.D. This paper should not be entitled "liver abscesses."

More information

Vascular Imaging in the Pediatric Abdomen. Jonathan Swanson, MD

Vascular Imaging in the Pediatric Abdomen. Jonathan Swanson, MD Vascular Imaging in the Pediatric Abdomen Jonathan Swanson, MD Goals and Objectives To understand the imaging approach, appearance, and clinical manifestations of the common pediatric abdominal vascular

More information

Abdominal Pain and Abnormal Liver Tests After Orthotopic Liver Transplantation

Abdominal Pain and Abnormal Liver Tests After Orthotopic Liver Transplantation Abdominal Pain and Abnormal Liver Tests After Orthotopic Liver Transplantation M. Muñoz-Navas 1, J. Baillie 2 1 University of Pamplona, Pamplona, Spain [Guest Discussant] 2 Dept. of Medicine, Duke University

More information

Management of biliary injury after laparoscopic cholecystectomy N. Dayes Kings County Hospital Center & Long Island College Hospital 8/19/2010

Management of biliary injury after laparoscopic cholecystectomy N. Dayes Kings County Hospital Center & Long Island College Hospital 8/19/2010 Management of biliary injury after laparoscopic cholecystectomy N. Dayes Kings County Hospital Center & Long Island College Hospital 8/19/2010 Case Presentation 30 y.o. woman with 2 weeks of RUQ abdominal

More information

Post Laparoscopic Cholecystectomy Biloma in a Child Managed by Endoscopic Retrograde Cholangio-Pancreatography and Stenting: A Case Report

Post Laparoscopic Cholecystectomy Biloma in a Child Managed by Endoscopic Retrograde Cholangio-Pancreatography and Stenting: A Case Report pissn: 2234-8646 eissn: 2234-8840 https://doi.org/10.5223/pghn.2016.19.4.281 Pediatr Gastroenterol Hepatol Nutr 2016 December 19(4):281-285 Case Report PGHN Post Laparoscopic Cholecystectomy Biloma in

More information

Biliary complications, including biliary leaks and

Biliary complications, including biliary leaks and Use of CT Cholangiography to Evaluate the Biliary Tract After Liver Transplantation: Initial Experience Gregg A. Miller, 1 Benjamin M. Yeh, 1 Richard S. Breiman, 1 John P. Roberts, 2 Aliya Qayyum, 1 and

More information

The Art of Angioplasty

The Art of Angioplasty The Art of Angioplasty Achieving and Defining Success Thomas M. Vesely, MD Saint Louis, Missouri Dr. Vesely is a consultant for: W.L. Gore & Associates Lutonix Imaging the Vascular Access Circuit A well

More information

Respiratory complications are a major contributing factor to postoperative morbidity and mortality in pediatric liver transplantation.

Respiratory complications are a major contributing factor to postoperative morbidity and mortality in pediatric liver transplantation. Real-time ultrasound-guided pigtail catheter placement in supine position for drainage of symptomatic pleural effusions in paediatric patients who underwent liver transplantation Poster No.: B-0163 Congress:

More information

Percutaneous cholecystostomy for the treatment of acute cholecystitis in the critically ill and elderly

Percutaneous cholecystostomy for the treatment of acute cholecystitis in the critically ill and elderly ORIGINAL ARTICLE Key words: Cholecystectomy; Cholecystostomy!!"#!" JCM Li DWH Lee CW Lai ACN Li DW Chu ACW Chan Hong Kong Med J 2004;10:389-93 North District Hospital, New Territories East Cluster, 9 Po

More information

Title: Cholestasis after TIPS placement in a patient with primary sclerosing cholangitis: an uncommon complication

Title: Cholestasis after TIPS placement in a patient with primary sclerosing cholangitis: an uncommon complication Title: Cholestasis after TIPS placement in a patient with primary sclerosing cholangitis: an uncommon complication Authors: Alejandro Salagre García, Carolina Muñoz Codoceo, Elena Gómez Domínguez, Inmaculada

More information

Percutaneous Biliary Forceps Biopsy for Suspect Malignant Biliary Obstruction

Percutaneous Biliary Forceps Biopsy for Suspect Malignant Biliary Obstruction Chin J Radiol 2004; 29: 123-127 123 Percutaneous Biliary Forceps Biopsy for Suspect Malignant Biliary Obstruction ANDY SHAU-BIN CHOU 1,3 PAU-YANG CHANG 1 YUNG-HSIANG HSU 2 CHAU-CHIN LEE 1 SEA-KIAT LEE

More information

Bile Duct Injury during Lap Chole. Bile Duct Injury during cholecystectomy TOPICS. 1. Prevalence, mechanisms, prevention and diagnosis

Bile Duct Injury during Lap Chole. Bile Duct Injury during cholecystectomy TOPICS. 1. Prevalence, mechanisms, prevention and diagnosis Bile Duct Injury during cholecystectomy Catherine HUBERT Jean-Fran François GIGOT Benoît t NAVEZ Division of Hepato-Biliary Biliary-Pancreatic Surgery Department of Abdominal Surgery and Transplantation

More information

Early Posttransplantation Portal Vein Stenosis Following Living Donor Liver Transplantation: Percutaneous Transhepatic Primary Stent Placement

Early Posttransplantation Portal Vein Stenosis Following Living Donor Liver Transplantation: Percutaneous Transhepatic Primary Stent Placement LIVER TRANSPLANTATION 13:530-536, 2007 ORIGINAL ARTICLE Early Posttransplantation Portal Vein Stenosis Following Living Donor Liver Transplantation: Percutaneous Transhepatic Primary Stent Placement Gi-Young

More information

Percutaneous Cholecystostomy Catheter Removal and Incidence of Clinically Significant Bile Leaks: A Clinical Approach to Catheter Management

Percutaneous Cholecystostomy Catheter Removal and Incidence of Clinically Significant Bile Leaks: A Clinical Approach to Catheter Management Interventional Radiology Wise et al. Cholecystostomy Catheter Removal and Incidence of Bile Leaks James N. Wise 1 Debra A. Gervais Andrew Akman Mukesh Harisinghani Peter F. Hahn Peter R. Mueller Wise JN,

More information

The Bile Duct (and Pancreas) and the Physician

The Bile Duct (and Pancreas) and the Physician The Bile Duct (and Pancreas) and the Physician Javaid Iqbal Consultant in Gastroenterology and Pancreato-biliary Medicine University Hospital South Manchester Not so common?! Two weeks 38 ERCP s 20 15

More information

Radiofrequency Ablation of Liver Tumors

Radiofrequency Ablation of Liver Tumors Radiofrequency Ablation of Liver Tumors Michael M. Awad, Michael A. Choti Indications and Contraindications Indications Unresectable malignant tumors of the liver (e.g., hepatocellular carcinoma, colorectal

More information

Lutheran Medical Center. Daniel H. Hunt, M.D. June 10 th, 2005

Lutheran Medical Center. Daniel H. Hunt, M.D. June 10 th, 2005 Lutheran Medical Center Daniel H. Hunt, M.D. June 10 th, 2005 History xx y.o. pt with primary CBD stones s/p ERCP xx months earlier for attempted stone extraction resulting in post ERCP pancreatitis. Patient

More information

Classification of choledochal cyst with MR cholangiopancreatography in children and infants: special reference to type Ic and type IVa cyst

Classification of choledochal cyst with MR cholangiopancreatography in children and infants: special reference to type Ic and type IVa cyst Classification of choledochal cyst with MR cholangiopancreatography in children and infants: special reference to type Ic and type IVa cyst Poster No.: C-1333 Congress: ECR 2011 Type: Educational Exhibit

More information

Stenting of the Cystic Duct in Benign Disease: A Definitive Treatment for the Elderly and Unwell

Stenting of the Cystic Duct in Benign Disease: A Definitive Treatment for the Elderly and Unwell Cardiovasc Intervent Radiol (2015) 38:964 970 DOI 10.1007/s00270-014-1014-y CLINICAL INVESTIGATION NON-VASCULAR INTERVENTIONS Stenting of the Cystic Duct in Benign Disease: A Definitive Treatment for the

More information

NYU School of Medicine Department of Radiology Rotation-Specific House Staff Evaluation

NYU School of Medicine Department of Radiology Rotation-Specific House Staff Evaluation Vascular & Interventional Radiology Rotation 1 Core competency in vascular and interventional radiology during the first resident rotation consists of clinical objectives, technical objectives and image

More information

Principles of ERCP: papilla cannulation, indications/contraindications and risks. Dr. med. Henrik Csaba Horváth PhD

Principles of ERCP: papilla cannulation, indications/contraindications and risks. Dr. med. Henrik Csaba Horváth PhD Principles of ERCP: papilla cannulation, indications/contraindications and risks Dr. med. Henrik Csaba Horváth PhD Evolution of ERCP 1968. 1970s ECPG Endoscopic CholangioPancreatoGraphy Japan 1974 Biliary

More information

Cholangiocarcinoma: Radiologic evaluation and interventions

Cholangiocarcinoma: Radiologic evaluation and interventions November 2014 Cholangiocarcinoma: Radiologic evaluation and interventions Colin Nevins, Harvard Medical School Year III Agenda Initial course and work-up Endoscopic retrograde cholangiopancreatography

More information

Biliary Anatomy in Living-related Liver Transplantation

Biliary Anatomy in Living-related Liver Transplantation The 5th IHPBA Congress - Istanbul Biliary Anatomy in Living-related Liver Transplantation biliary trees hilar plate Assessment for Vascular Anatomy 1. 3DCT portal vein hepatic vein hepatic artery 2. No

More information

Percutaneous Transhepatic Treatment of Hepaticojejunal Anastomotic Biliary Strictures After Living Donor Liver Transplantation

Percutaneous Transhepatic Treatment of Hepaticojejunal Anastomotic Biliary Strictures After Living Donor Liver Transplantation LIVER TRANSPLANTATION 14:1323-1332, 2008 ORIGINAL ARTICLE Percutaneous Transhepatic Treatment of Hepaticojejunal Anastomotic Biliary Strictures After Living Donor Liver Transplantation Gi-Young Ko, 1 Kyu-Bo

More information

Percutaneous Transhepatic Cholangiogram (PTC) and Biliary Drainage UHB is a no smoking Trust

Percutaneous Transhepatic Cholangiogram (PTC) and Biliary Drainage UHB is a no smoking Trust Percutaneous Transhepatic Cholangiogram (PTC) and Biliary Drainage UHB is a no smoking Trust To see all of our current patient information leaflets please visit www.uhb.nhs.uk/patient-information-leaflets.htm

More information

Biliary Atresia. Karen F. Murray, MD Professor of Pediatrics Director, Hepatobiliary Program Seattle Children s

Biliary Atresia. Karen F. Murray, MD Professor of Pediatrics Director, Hepatobiliary Program Seattle Children s Biliary Atresia Karen F. Murray, MD Professor of Pediatrics Director, Hepatobiliary Program Seattle Children s Biliary Atresia Incidence: 1/8,000-15,000 live births Girls > boys 1.5:1 The most common cause

More information

Index. Note: Page numbers of article titles are in boldface type.

Index. Note: Page numbers of article titles are in boldface type. Index Note: Page numbers of article titles are in boldface type. A Acute variceal bleeding management of, 251 262 balloon tamponade of esophagus in, 257 258 endoscopic therapies in, 255 257. See also Endoscopy,

More information

INTRODUCTION. Key Words: Biliary stenting; Biliary stricture; Duct-toduct biliary anastomosis; Endoscopic retrograde cholangiography; original article

INTRODUCTION. Key Words: Biliary stenting; Biliary stricture; Duct-toduct biliary anastomosis; Endoscopic retrograde cholangiography; original article Gut and Liver, Vol. 4, No. 2, June 2010, pp. 226-233 original article Biliary Stricture after Adult Right-Lobe Living-Donor Liver Transplantation with Duct-to-Duct Anastomosis: Long-Term Outcome and Its

More information

Naoyuki Toyota, Tadahiro Takada, Hodaka Amano, Masahiro Yoshida, Fumihiko Miura, and Keita Wada

Naoyuki Toyota, Tadahiro Takada, Hodaka Amano, Masahiro Yoshida, Fumihiko Miura, and Keita Wada J Hepatobiliary Pancreat Surg (2006) 13:80 85 DOI 10.1007/s00534-005-1062-4 Endoscopic naso-gallbladder drainage in the treatment of acute cholecystitis: alleviates inflammation and fixes operator s aim

More information

Case Scenario 1. Discharge Summary

Case Scenario 1. Discharge Summary Case Scenario 1 Discharge Summary A 69-year-old woman was on vacation and noted that she was becoming jaundiced. Two months prior to leaving on that trip, she had had a workup that included an abdominal

More information

Overview of PSC Making the Diagnosis

Overview of PSC Making the Diagnosis Overview of PSC Making the Diagnosis Tamar Taddei, MD Assistant Professor of Medicine Yale University School of Medicine Overview Definition Epidemiology Diagnosis Modes of presentation Associated diseases

More information

Staging & Current treatment of HCC

Staging & Current treatment of HCC Staging & Current treatment of HCC Dr.: Adel El Badrawy Badrawy; ; M.D. Staging & Current ttt of HCC Early stage HCC is typically silent. HCC is often advanced at first manifestation. The selective ttt

More information

Interventional Radiology for Improved Outcomes in the Neonatal Period

Interventional Radiology for Improved Outcomes in the Neonatal Period Interventional Radiology for Improved Outcomes in the Neonatal Period Mark J. Hogan, MD Nationwide Children s Hospital The Ohio State University mark.hogan@nationwidechildrens.org No financial disclosures

More information

Outcome of donor biliary complications following living donor liver transplantation

Outcome of donor biliary complications following living donor liver transplantation ORIGINAL ARTICLE Korean J Intern Med 2018;33:705-715 Outcome of donor biliary complications following living donor liver transplantation Hyun Young Woo 1, In Seok Lee 2, Jae Hyuck Chang 2, Seung Bae Youn

More information

Correspondence should be addressed to Justin Cochrane;

Correspondence should be addressed to Justin Cochrane; Case Reports in Gastrointestinal Medicine Volume 2015, Article ID 794282, 4 pages http://dx.doi.org/10.1155/2015/794282 Case Report Acute on Chronic Pancreatitis Causing a Highway to the Colon with Subsequent

More information

Radiology. Gastrointestinal. Experience with Percutaneous Transhepatic Cholangiography Using the Japanese Needle

Radiology. Gastrointestinal. Experience with Percutaneous Transhepatic Cholangiography Using the Japanese Needle Gastrointest Radiol 2, 359 365 (1978) Gastrointestinal Radiology Experience with Percutaneous Transhepatic Cholangiography Using the Japanese Needle Joe Ariyama 1, Hikoo Shirakabe 1, Kazuhiko Ohashi 1,

More information

Liver Transplantation for Biliary Atresia: 19-Year, Single-Center Experience

Liver Transplantation for Biliary Atresia: 19-Year, Single-Center Experience Liver Transplantation for Biliary Atresia: 19-Year, Single-Center Experience L Thomas Chin 1, Anthony M D Alessandro 1, Stuart J Knechtle 1, Luis A Fernandez 1, Glen Leverson 1, Robert H Judd 2, Elizabeth

More information

Case 7729 Child with choledochal cyst presenting with episodes of vomitting and jaundice

Case 7729 Child with choledochal cyst presenting with episodes of vomitting and jaundice Case 7729 Child with choledochal cyst presenting with episodes of vomitting and jaundice dos Santos R 1, Almeida J 1, Mendes PP 2, Pereira S 3, Borges C 3, Soares E 4. 1) Radiology resident, 2) Radiology

More information

Portal Vein in a Patient Undergoing Hepatic Resection

Portal Vein in a Patient Undergoing Hepatic Resection HPB Surgery, 1997, Vol. 10, pp. 323-327 Reprints available directly from the publisher Photocopying permitted by license only (C) 1997 OPA (Overseas Publishers Association) Amsterdam B.V. Published in

More information

Bile Duct Injuries. Dr. Bennet Rajmohan, MRCS (Eng), MRCS Ed Consultant General & Laparoscopic Surgeon Apollo Speciality Hospitals Madurai, India

Bile Duct Injuries. Dr. Bennet Rajmohan, MRCS (Eng), MRCS Ed Consultant General & Laparoscopic Surgeon Apollo Speciality Hospitals Madurai, India Bile Duct Injuries Dr. Bennet Rajmohan, MRCS (Eng), MRCS Ed Consultant General & Laparoscopic Surgeon Apollo Speciality Hospitals Madurai, India Introduction Bile duct injury (BDI) rare but potentially

More information

of bile leakage after liver resecti

of bile leakage after liver resecti NAOSITE: Nagasaki University's Ac Title Author(s) Citation Percutaneous embolization with n-bu of bile leakage after liver resecti Kuroki, Tamotsu; Kitasato, Amane; T Hiroaki; Taniguchi, Ken; Maeda, Shi

More information

The Endoscopic Management of PSC

The Endoscopic Management of PSC The Endoscopic Management of PSC Raj J. Shah, M.D. Associate Professor of Medicine Director, Pancreaticobiliary Endoscopy Services University of Colorado at Denver and the Health Sciences Center Why did

More information

Procedures/Risks:central venous catheter

Procedures/Risks:central venous catheter Procedures/Risks:central venous catheter Central Venous Catheter Placement Procedure: Placement of the central venous catheter will take place in the Interventional Radiology Department (IRD) at The Ohio

More information

Rokitansky-Aschoff sinuses are epithelial invaginations in the gallbladder wall that from as a result of increased gallbladder pressures.

Rokitansky-Aschoff sinuses are epithelial invaginations in the gallbladder wall that from as a result of increased gallbladder pressures. Anatomy The complexity of the biliary tree can be broken down into much simpler segments. The intrahepatic ducts converge to form the right and left hepatic ducts which exit the liver and join to become

More information

Original Research Article

Original Research Article Original Research Article A Study of of Intra-Abdominal Collections and Abscesses Senthil Anbumani 1, Anita Soundarapandian 2 1 Associate Professor, Department of Radiology, ACS Medical College and Hospital,

More information

Overall Goals and Objectives for Transplant Hepatology EPAs:

Overall Goals and Objectives for Transplant Hepatology EPAs: Overall Goals and Objectives for Transplant Hepatology EPAs: 1. DIAGNOSTIC LIST During the one-year Advanced Pediatric Transplant Hepatology Program, fellows are expected to develop comprehensive skills

More information

The Focused Assessment with Sonography for Trauma, (FAST) procedure.

The Focused Assessment with Sonography for Trauma, (FAST) procedure. The Focused Assessment with Sonography for Trauma, (FAST) procedure. ROBERT H. WRIGLEY Professor Veterinary Diagnostic Imaging University of Sydney Veterinary Teaching Hospital Professor Emeritus Colorado

More information

TIAN AND OTHERS common hepatic artery. For LDLT, a microvascular technique was employed to anastomose the donor artery to either the right or left hep

TIAN AND OTHERS common hepatic artery. For LDLT, a microvascular technique was employed to anastomose the donor artery to either the right or left hep Original Article Treatment of Hepatic Artery Thrombosis After Orthotopic Liver Transplantation Ming Guo Tian, Wai Kuen Tso, 1 Chung Mau Lo, Chi Leung Liu and Sheung Tat Fan, Departments of Surgery and

More information

Risk Factors for Development of Biliary Stricture in Patients Presenting with Bile Leak after Cholecystectomy

Risk Factors for Development of Biliary Stricture in Patients Presenting with Bile Leak after Cholecystectomy Gut and Liver, Vol. 7, No. 3, May 2013, pp. 352-356 ORiginal Article Risk Factors for Development of Biliary Stricture in Patients Presenting with Bile Leak after Cholecystectomy Hosur Mayanna Lokesh,

More information

Review of Percutaneous Biliary Drainage in Malignant Biliary Obstruction and Accompanying Bilomas

Review of Percutaneous Biliary Drainage in Malignant Biliary Obstruction and Accompanying Bilomas Article ID: WMC003123 ISSN 2046-1690 Review of Percutaneous Biliary Drainage in Malignant Biliary Obstruction and Accompanying Bilomas Corresponding Author: Dr. Bilgin Kadri Aribas, Radiologist, Department

More information

Afferent Loop Syndrome: Treatment by Means of the Placement of Dual Stents

Afferent Loop Syndrome: Treatment by Means of the Placement of Dual Stents Vascular and Interventional Radiology Original Research Han et al. Use of Dual Stents for Treatment of Afferent Loop Syndrome Vascular and Interventional Radiology Original Research Kichang Han 1 Ho-Young

More information

The role for contrast-enhanced ultrasonography outside of focal liver lesions

The role for contrast-enhanced ultrasonography outside of focal liver lesions The role for contrast-enhanced ultrasonography outside of focal liver lesions Paul S. Sidhu King s College Hospital, London, UK Introduction Contrast-enhanced ultrasonography (US) of focal liver lesions

More information

Can Doppler Sonography Discern Between Hemodynamically Significant and Insignificant Portal Vein Stenosis After Adult Liver Transplantation?

Can Doppler Sonography Discern Between Hemodynamically Significant and Insignificant Portal Vein Stenosis After Adult Liver Transplantation? Vascular and Interventional Radiology Original Research Mullan et al. Sonography of Portal Vein Stenosis Vascular and Interventional Radiology Original Research Charles P. Mullan 1 Bettina Siewert Robert

More information

Abdomen Sonography Examination Content Outline

Abdomen Sonography Examination Content Outline Abdomen Sonography Examination Content Outline (Outline Summary) # Domain Subdomain Percentage 1 2 3 Anatomy, Perfusion, and Function Pathology, Vascular Abnormalities, Trauma, and Postoperative Anatomy

More information

Case 8038 Renal allograft complicated with renal artery stenosis

Case 8038 Renal allograft complicated with renal artery stenosis Case 8038 Renal allograft complicated with renal artery stenosis Santiago I, Canelas A, Pinto AP Section: Cardiovascular Published: 2009, Nov. 30 Patient: 61 year(s), male Clinical History A 61-year-old

More information

Liver Transplantation

Liver Transplantation 1 Liver Transplantation Department of Surgery Yonsei University Wonju College of Medicine Kim Myoung Soo M.D. ysms91@wonju.yonsei.ac.kr http://gs.yonsei.ac.kr History Development of Liver transplantation

More information

A Primer on Central Venous Access: Peripherally-Inserted Central Catheters, Tunneled Catheters, and Subcutaneous Ports

A Primer on Central Venous Access: Peripherally-Inserted Central Catheters, Tunneled Catheters, and Subcutaneous Ports Disclosures A Primer on Central Venous Access: Peripherally-Inserted Central Catheters, Tunneled Catheters, and Subcutaneous Ports No conflicts of interest relevant to this presentation Jason W. Pinchot,

More information

Induction Immunosuppression With Rabbit Antithymocyte Globulin in Pediatric Liver Transplantation

Induction Immunosuppression With Rabbit Antithymocyte Globulin in Pediatric Liver Transplantation LIVER TRANSPLANTATION 12:1210-1214, 2006 ORIGINAL ARTICLE Induction Immunosuppression With Rabbit Antithymocyte Globulin in Pediatric Liver Transplantation Ashesh Shah, 1 Avinash Agarwal, 1 Richard Mangus,

More information

EVALUATION & LISTING. Your Child s Liver Transplant Evaluation. What is the Liver?

EVALUATION & LISTING. Your Child s Liver Transplant Evaluation. What is the Liver? EVALUATION & LISTING Your Child s Liver Transplant Evaluation The University of Michigan is a national leader in liver transplantation, as well as the surgical and medical management of patients with liver

More information

Classification and Prognosis of Intrahepatic Biliary Stricture After Liver Transplantation

Classification and Prognosis of Intrahepatic Biliary Stricture After Liver Transplantation LIVER TRANSPLANTATION 13:1736-1742, 2007 ORIGINAL ARTICLE Classification and Prognosis of Intrahepatic Biliary Stricture After Liver Transplantation Hae Won Lee, 1 Kyung-Suk Suh, 1 Woo Young Shin, 1 Eung-Ho

More information

RECURRENT PYOGENIC CHOLANGITIS

RECURRENT PYOGENIC CHOLANGITIS RECURRENT PYOGENIC CHOLANGITIS Resident(s): Evan Raff, MD MHA Attending(s): Narasimham Dasika, MD Program/Dept(s): University of Michigan Health System, Department of Radiology CHIEF COMPLAINT & HPI Chief

More information

Biliary Complications in Liver Transplantation

Biliary Complications in Liver Transplantation 10 Biliary Complications in Liver Transplantation Ilka de Fatima Santana Ferreira Boin, Fernando Romani de Araujo, Elaine Cristina de Ataide, Anaisa Portes Ramos and Ciro Garcia Montes Unit of Liver Transplantation

More information