Percutaneous Transhepatic Cholangiography

A transhepatic cholangiography is an invasive imaging study that shows the bile ducts in the liver. During this procedure, a contrast medium is injected into one of the bile ducts in the liver, and x-rays are then taken. The contrast is injected by a needle that is placed into one of the bile ducts through the skin and liver. A catheter may also be placed for therapeutic reasons.

The placement of the needle is done under image guidance, which means that ultrasound and x-ray are used. This increases the accuracy of needle placement and decreases the likelihood of bleeding and other complications.

When might a percutaneous transhepatic cholangiography be needed?

Percutaneous transhepatic cholangiography is done when your child has or is suspected to have narrowing or blockage of the bile ducts draining the liver and the site and nature of the blockage needs to be determined for medical care. It is often combined in one procedure with therapy to relieve the blockage or to drain the bile from the liver.

How should I prepare my child for a percutaneous transhepatic cholangiography?

You will be given written instructions prior to the procedure. In order to prepare for the anesthesia or sedation, your child must not eat any solid foods for eight hours before the procedure and not drink any clear fluids for three hours before to the procedure.

Explain in simple terms why the procedure is needed and what will happen.

• Assure your child that you will be close by during the procedure.
• Your child may bring a favorite toy or blanket into the room.

What should I expect when I bring my child to the hospital for a percutaneous transhepatic cholangiography?

You will be instructed by the day surgery nurse or at the time of your pre-op visit

• where and when you will need to arrive for your procedure
• when your child should stop eating or drinking

The interventional radiologist will explain the procedure to you and your child. Before the procedure begins, you must sign a consent form. You must be your child’s legal guardian to sign this form. If you are a legal guardian and not a parent, you must bring legal paperwork with you showing proof of legal guardianship.

What happens during a percutaneous transhepatic cholangiography?

• Once your child has been given medication to make him relax or go to sleep, the skin over his abdomen is cleaned with a special iodine solution and covered with drapes in order to prevent infection.
• Local anesthetic (freezing medication) is injected into his skin.
• Once the area is numb, the interventional radiologist uses ultrasound or x-ray images to guide the needle into one of the bile ducts.
• Once the needle is in good position, contrast medium is injected into the bile ducts. The contrast injection allows the radiologist to see all of the bile ducts in the liver and determine whether or not any of them are abnormally blocked or enlarged. It also outlines any gallstones or other abnormal material within the bile ducts.
• A number of x-ray images are taken in different positions to outline all of the bile ducts.
• The radiologist may replace the needle with a small catheter (tube) to permit more precise injection or to drain the bile.

Three possible therapeutic options that can be performed through the catheter at the same time or during future procedures include:

• balloon dilation of narrowings in the bile ducts
• removal of gallstones with a special basket device
• placement of a stent (tube of metallic mesh) across a blocked bile duct

Alternatively, the radiologist may decide to leave a special soft catheter in place to continue draining the bile.

What happens after the percutaneous transhepatic cholangiography?

• A nurse will take your child to the Interventional Radiology Post-Anesthesia Care Unit (PACU). You will be allowed to come to the recovery area.
• The nurse will monitor your child closely until your child is admitted or returned to his hospital bed.
• The interventional radiologist will speak with you about the procedure.

Is a percutaneous transhepatic cholangiography safe?

Percutaneous transhepatic cholangiography, when performed by an appropriately trained and experienced interventional radiologist, is a safe procedure which is usually performed under sedation or general anesthesia. As with all invasive procedures, complications and side effects may occur. These will be explained to you in detail before you give your consent.

Your child will be exposed to ionizing radiation (x-rays) during the procedure. We believe that the benefit to your child’s health outweighs the exposure that occurs during the percutaneous transhepatic cholangiography. Because children are more sensitive to radiation exposure than adults, we have been leaders in adjusting equipment and procedures to deliver the lowest possible dose to young patients.

How do I learn the results of the percutaneous transhepatic cholangiography?

The interventional radiologist will inform you of the results immediately after the procedure. If you have any questions, please speak to your child’s doctor.

How Boston Children’s Hospital approaches percutaneous transhepatic cholangiography

Our pediatric interventional radiologists, the doctors who do the procedure, are highly trained in the performance of invasive procedures on infants and children.

In addition to the interventional radiologist, your child will be cared for by a team of anesthesiologists, nurse practitioners, nurses, and technologists who specialize in caring for children undergoing interventional radiology procedures and treatments.

We perform percutaneous transhepatic cholangiographies in our suite on the second floor of the hospital, which features three procedure rooms equipped with the latest imaging technology, a recovery area for patients who have received sedation or anesthesia, and examining rooms for outpatient visits.