Transhepatic Biliary Catheterization
Transhepatic biliary catheterization is a surgical procedure during which a catheter is inserted into the bile duct to relieve an obstruction.
Bile is a fluid made in the liver and stored in the gall bladder. The function of bile is to break down fats during digestion. When fatty foods move into the intestine, bile is released from the gall bladder, travels through the bile duct, and enters the first part of the small intestine (duodenum).
If the bile duct is blocked, the skin becomes yellowish (jaundiced), the abdomen is painful, and a fever develops. The bile duct can be blocked by gallstones, surgical injury, infection in the duct, or by tissue growth due to cancer. Transhepatic biliary catheterization is performed to relieve bile duct blockage. The most common reason for this procedure is to relieve obstruction from the overgrowth of cancer cells. Obstruction due to gallstones is usually cleared by other means.
Transhepatic biliary catheterization is done when cancer has progressed to the point where all the malignant cells cannot be removed by surgery. Patients who need transhepatic biliary catheterization often suffer from additional complications of their cancer. Because of the likelihood of bleeding from the liver, this procedure should not be done on patients who have blood clotting abnormalities.
Transhepatic biliary catheterization is performed by inserting a needle through the skin, into the abdomen, through the liver, and into the bile duct. A wire attached to the needle then guides the catheter into place. The procedure can take several hours. The patient is given medication for pain.
The catheter can either reestablish bile flow into the duodenum or reroute the bile so it drains into a bag outside the body. The choice depends on the extent and position of the obstruction.
The standard preoperative blood tests are performed. The patient should not eat or drink the day of the procedure.
The patient must stay in bed after the procedure for at least six hours, to reduce the risk of bleeding. A nurse checks vital signs and looks for indications of complication such as pain, cramping, or leakage around the catheter. The catheter is flushed periodically to keep it open. Patient and caregiver education on how to keep the catheter clean and irrigated is an important part of aftercare.
The most common complication of transhepatic biliary catheterization is bleeding as a result of puncturing the liver. Infection may also result from this procedure. Sometimes the catheter itself becomes blocked and is ineffective.
Transhepatic biliary catheterization is a treatment, not a cure. Successful treatment relieves the blocked bile duct, but does not change the underlying conditions that caused the blockage.
"Insertion of a Catheter to Relieve Bile Duct Obstruction." In Everything You Need to Know About Medical Treatments. Springhouse, PA: Springhouse Corp., 1996.
National Cancer Institute. Building 31, Room 10A31, 31 Center Drive, MSC 2580, Bethesda, MD 20892-2580. (800) 422-6237. <http://www.nci.nih.gov>.
"Extrahepatic Bile Duct Cancer." National Cancer Institute Page. <http://www.nci.nih.gov>.