Percutaneous transhepatic cholangiography

Percutaneous transhepatic cholangiography, percutaneous hepatic cholangiogram (PTHC) is a radiological technique used to visualize the anatomy of the biliary tract. A contrast medium is injected into a bile duct in the liver, after which X-rays are taken. It allows access to the biliary tree in cases where endoscopic retrograde cholangiopancreatography has been unsuccessful. Initially reported in 1937, the procedure became popular in 1952. Some uses for this procedure includes: drainage of bile/infected bile to relieve obstructive jaundice, to place a stent to dilate a stricture in the biliary system, stone removal, and rendezvous technique where guidewire from the common bile duct (CBD) meets with duodenoscope (coming from the oesophagus into the stomach and then duodenum) at the major duodenal papilla. In this rendezvous technique, the guidewire is then pulled into duodenoscope and a small blade is slid over the guidewire into the CBD and perform surgeries on a specific bile duct in the biliary system. PTHC is frequently performed guide therapy of the biliary system. Rarely it is used for diagnostic purposes only. PTHC is also used in the drainage of unruptured or uncomplicated hydatid cysts. Rarely, PTHC is used in the drainage of ruptured hydatid cysts. Among the contraindications are: increased bleeding tendency where platelets less than 100x109/litre and prothrombin time prolonged more than 2 seconds than the control. This procedure is also contraindicated in biliary tract sepsis, except to control the infection by drainage of the infected bile. Low osmolar contrast medium is used in this procedure with concentration of 150 mg/ml with 20 to 60 ml volume. Those who undergoes the procedure needs to be fasted for four hours before the procedure. Besides, antibiotics such as ciprofloxacin 500 mg to 750 mg can be given as antibiotic prophylaxis to prevent infection during the procedure. Sedation (to reduce irritability and agitation of the subject during procedure) with analgesia (painkillers) and vital signs monitoring should be set up.