Ann Hepatobiliary Pancreat Surg.  2018 Aug;22(3):282-286. 10.14701/ahbps.2018.22.3.282.

Percutaneous transhepatic biliary drainage catheter fracture: A case report

• Kwan JR
• Low KS
• Lohan R
• Shelat VG

• KMID: 2420618
• DOI: http://doi.org/10.14701/ahbps.2018.22.3.282

Abstract

Percutaneous transhepatic biliary drainage (PTBD) is safe treatment for biliary decompression given certain indications. However, this is temporary until definitive drainage is established. We report on a 76-year-old lady with recurrent pyogenic cholangitis and PTBD catheter fracture. She had hepatitis B virus-related Child-Pugh class A liver cirrhosis, hypothyroidism, hyperlipidaemia, and previous atrial fibrillation with a background of mild mitral, tricuspid and aortic valvular regurgitation. She had history of laparoscopic cholecystectomy in the past. She was deemed to be a high operative risk and declined hepatic resection. She had undergone multiple endoscopic and percutaneous biliary interventions to control sepsis and stone burden. A bilateral PTBD catheter was left in situ with plans for 3-monthly change. However, she defaulted follow-up and presented 11 months later with complaints of pain over the drain site and inability to flush the right catheter. Abdominal X-ray and computed tomography scans detected right catheter fracture at two places, making three fragments. She underwent percutaneous removal of the proximal fragment by an interventional radiology team. A temporary 4 Fr catheter was inserted to maintain biliary access. Endoscopic removal of the intra-biliary fragments was done the next day. Complete removal was confirmed on fluoroscopy. Finally, the 4 Fr catheter was replaced by a new 12 Fr catheter. The patient was discharged well.

Keyword

Biliary drainage; Catheter fracture; Cholangitis

MeSH Terms

Aged
Atrial Fibrillation
Catheters*
Cholangitis
Cholecystectomy, Laparoscopic
Decompression
Drainage*
Fluoroscopy
Follow-Up Studies
Hepatitis B
Humans
Hypothyroidism
Liver Cirrhosis
Radiology, Interventional
Sepsis

Figure

• 

  Fig. 1 Abdominal X-ray showing intrabiliary fracture of a right percutaneous transhepatic biliary drainage (PTBD) catheter (arrow A) and normal left-side PTBD catheter.

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  Fig. 2 Computed tomography scan showing fractured right biliary drainage catheter at liver capsule with gap between fragments (arrow B).

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  Fig. 3 Endoscopic view of distal fracture fragment (arrow A), intact left PTBD catheter (Arrow B), and temporarily inserted 4 Fr right biliary catheter (arrow C).

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  Fig. 4 Fluoroscopic image after removal of fractured right PTBD catheter with 12 Fr replacement catheter.

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