Percutaneous transhepatic cholangiogram (PTC)

Indications

- Evaluation of biliary obstruction in patients in whom ERCP has failed or patients with Roux-en-Y hepaticojejunostomy.

Advantages

-Best examination to assess site and morphology of obstruction close to the hilum (as opposed to ERCP, which is better for distal obstruction).

- Can characterize the nature of diffuse intrahepatic biliary disease such as primary sclerosing cholangitis

- Provides guidance and access for percutaneous transhepatic biliary drainage and possible stent placement to treat obstruction.

Disadvantages

- Invasive; requires special training

- Performed with conscious sedation

Contraindications and risks

- Ascites may present a contraindication

Patient preparation

- NPO for 4-6 hour

- Sterile technique, assessment of clotting parameters, correction of coagulopathy

- Performed with conscious sedation

diagnostic tests p.273

OBE: SCORE: RECALL: HOW TO CLOSE A LIVER DRAIN SITE [RECALL][DOANE][3/6/21]

RECALL, DOANE, 3/6/11

SURGERY: 3/5/21

- This patient presented with obstructive jaundice, was found to have an ampullary mass, and had a PTC tube placed

- The patient was taken to the OR on 3/5/21 for a whipple procedure

- At the end of the procedure, we pulled out the PTC drain

- There was a resultant defect in the liver

- We closed this because you don't want bile to leak out of the defect in the liver where the drain entered the liver

- He closed it with 4-0 PDS suture

DICTATION

"The drain was removed in its entirety.... The surface of the drain tract in the liver was re-approximated with a 4-0 PDS suture through the capsule of segment VII around the tract. Surgicel was placed on top of the liver repair. No bile leakage was noted."