Hemobilia in percutaneous transhepatic cholangiostomy

Aim. To determine the dependence of the formation of vascular-biliary fistula with the bile ducts bleeding and along the drainage channel on the diameter of the puncture needle and access to the biliary tract.

Materials and methods. A retrospective analysis of the results of treatment of 3786 cases of percutaneous transhepatic cholangiostomy using needles 17.5-18 G under Amplatz 0.035’ conductor with a safe J-tip was carried out. In the cholangiostomy in the bile ducts was installed biliary tree drainage shape memory No 8 Fr. In benign lesions of the bile ducts 2066 (54.6%) interventions were performed, 1720 (45.4%) for malignant ones. Central access to the bile ducts was performed in 2442 cases (64.5%), peripheral – in 1344 cases (35.5%).

Results. Significant hemobilia was observed in 21 (0.55%) cases: in 8 (0.47%) with a obstructive jaundice of malignant etiology, in 13 (0.63%) – benign etiology. In 3 cases, the cause of hemobilia was arteriobiliary fistula, in 16 – portobiliary, in 2 – biliovenous fistula. Central access was complicated by significant hemobilia in 10 patients, peripheral – in 11.

Conclusion. The low frequency of significant hemobilia – 0.55% – when using puncture needles 17.5–18 G for primary access to the bile ducts proves the validity of their use in radiological practice, and also does not allow to consider central access critical for the development of hemorrhagic complications in percutaneous transhepatic biliary drainage.

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