Kosin Med J.  2016 Dec;31(2):173-178. 10.7180/kmj.2016.31.2.173.

Endoscopic Removal of Remained Drawstring After Percutaneous Transhepatic Biliary Drainage

• Yoon TW
• Jung GY
• Park YJ
• Choi JY
• Jung JH
• Kim TG

• KMID: 2365242
• DOI: http://doi.org/10.7180/kmj.2016.31.2.173

Abstract

The percutaneous transhepatic biliary drainage (PTBD) is an effective intervention as a palliative therapy for relieving a jaundice and cholangitis. It may be used in place of Endoscopic retrograde cholangiopancreatography (ERCP) in the obstructive biliary disease. Recently, by developing invasive procedures, the incidence of the complications such as bleeding and perforation has been increasing in the diagnosis and treatment of hepatobiliary disease. We report here on a case of remained drawstring after PTBD in a 85-year-old man. The patient was conducted PTBD for relieving a jaundice and cholangitis. And then the patient had complained of abdominal pain constantly. A few days later, we removed PTBD and attempted ERCP for removal of CBD stone. The ERCP showed remained drawstring around ampulla of vater and we removed it by IT knife. The drawstring was successfully removed.

Keyword

Acute cholangitis; Endoscopic retrograde cholangiopancreatography (ERCP); Percutaneous transhepatic biliary drainage (PTBD)

MeSH Terms

Abdominal Pain
Aged, 80 and over
Ampulla of Vater
Cholangiopancreatography, Endoscopic Retrograde
Cholangitis
Diagnosis
Drainage*
Hemorrhage
Humans
Incidence
Jaundice
Palliative Care

Figure

• 

  Fig. 1. Black arrow in abdomen CT demonstrating 9mm sized biliary stone in the distal common bile duct.

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  Fig. 2–1. Endoscopy showed an ampulla of vater tightened by a remained drawstring after removing percutaneous transhepatic biliary drainage. Fig. 2–2. Endoscopy showed an ampulla of vater after removing a remained drawstring. Fig. 2–3. The remained drawstring to prevent a drainage tube from falling into the body.

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  Fig. 3. The twisted biliary tube on the duodenum.

Reference

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