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Percutaneous transhepatic cholangiography (PTC)
Percutaneous transhepatic cholangiography is a diagnostic procedure that involves the sterile placement of a small gauge needle into peripheral biliary radicles with use of imaging guidance, followed by contrast material injection to delineate biliary anatomy and potential biliary pathologic processes. PTC is often done for biliary drainage
What are the indications of PTC?
Indications (PTC is done when ERCP has failed)
Discuss the technique of PTC?
External drainage is not preferred as the catheters are prone to dislodgement. Catheter dislodgement is a serious complication as this can result in bile leak and biliary peritonitis. As the biliary system is then collapsed, treatment of this complication by percutaneous reinsertion of a second catheter is difficult if the intrahepatic ducts are not dilated and ERCP may not be possible. In this situation bile will continue to leak into the peritoneum and laparotomy may be required.
However, external drainage is sometimes done when the stricture is difficult to stent.
Discuss the complications of PTC?
Sepsis, haemorrhage, Pancreatitis, peritonitis
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