When is percutaneous cholecystostomy indicated? Although cholecystectomy is the preferred therapy for acute cholecystitis, some patients may not be surgical candidates because of their overall clinical status, sepsis, or other comorbid conditions. Percutaneous cholecystostomy combined with broad-spectrum antibiotic coverage is most commonly used as a temporizing measure until the patient’s clinical status may be optimized …
How to obtain a biopsy specimen of the bile ducts If a histologic diagnosis is required, what methods may be used to obtain a biopsy specimen of the bile ducts? When access to the bile ducts has been achieved, biopsy of a stricture site may be performed under fluoroscopic guidance. Various devices may be used …
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How does stricture morphology help to differentiate between benign and malignant disease? Benign biliary strictures tend to taper smoothly, with gradual narrowing across their length. Malignant biliary strictures, in contrast, are points of obstruction that end abruptly, sometimes with irregular borders or an appearance of “shouldering.”
What does the term isolated ducts mean? What is its significance? In the case of a low obstruction of the common bile duct, as would typically occur in the setting of a pancreatic head mass or common bile duct calculus, the right and left systems still communicate. Either a single right-sided biliary drain or a single left-sided …
What can be done to manage the treatment of malignant biliary obstruction after initial drainage? With some tumor types, access to the bile ducts allows for the placement of radioactive isotopes for ductal brachytherapy. If the patient is not a candidate for surgical resection, the drainage catheters may be left in long term. Sometimes, internal …
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Additional management measures to treat benign biliary obstruction After an initial drainage procedure, what additional management measures may be performed to treat benign biliary obstruction? Biliary drainage provides access to the bile ducts that may allow for retrieval of biliary calculi. Balloon dilation of benign ductal strictures with gradual upsizing of drainage catheter diameter may …
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What are the potential complications associated with percutaneous transhepatic biliary drainage? Even in the absence of clinical signs of cholangitis, bile in an obstructed system is often colonized with bacteria. Biliary sepsis, a potentially lethal complication, may occur during or after a cholangiogram or biliary drainage. Antibiotics should be given during biliary drainage procedures, and …
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