Percutaneous Transhepatic Cholangiography - My Child Has

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Percutaneous Transhepatic Cholangiography

Percutaneous Transhepatic Cholangiography

Programs that perform this procedure

Interventional Radiology Division

What is transhepatic cholangiography?

Transhepatic cholangiography is an invasive imaging study which precisely outlines the bile ducts in the liver. It is performed by an interventional radiologist using image guidance and involves placement of a needle and possibly a catheter directly through the skin and liver and into one of the bile ducts.

What is unique about transhepatic cholangiography at Children's Hospital Boston?

At Children's Hospital Boston, pediatric interventional radiologists (radiologists with specialized training in pediatric invasive techniques) perform this procedure using ultrasound guidance. Ultrasound guidance increases the accuracy of needle placement into the bile ducts and decreases the likelihood of bleeding and other complications. Children's Hospital Boston also has appropriately trained and experienced pediatric anesthesiologists, radiologic technologists, and nurses who are familiar with pediatric interventional techniques and the necessary patient care. Children's Hospital Boston also has appropriate modern imaging equipment needed for the performance of this technique.

When should I get a transhepatic cholangiogram?

The physicians involved in your care will decide when to recommend a transhepatic cholangiogram. In general, this technique is reserved for patients who have or are suspected to have blockage of the bile ducts draining the liver, and in whom precise demonstration of the site and nature of the blockage is needed for medical care. Transhepatic cholangiography is often combined in one procedure with therapy to relieve the blockage or to drain the bile from the liver.

Is it safe? Will it hurt?

Transhepatic cholangiography is a safe procedure when performed by experienced and appropriately trained interventional radiologists. Like any other invasive procedure, complications and side effects can occur. These will be explained to you in detail before you give consent for the procedure. In order to minimize any discomfort, transhepatic cholangiography in children is usually performed under general anesthesia or sedation (medicine given intravenously to relax the patient and control pain). There may be mild discomfort during the injection of a local anesthetic (numbing medication) into the skin prior to the insertion of the needle.

How should the patient prepare for the procedure?

You will be given written instructions prior to the procedure. In order to prepare for the anesthesia or sedation, the patient 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.

What will happen during the procedure?

The procedure is performed in the interventional suite in the Radiology Department. Once the patient has been given medication to make her/him relax or go to sleep, the skin over the abdomen is cleaned with a special iodine solution and covered with drapes in order to prevent infection. Local anesthetic (freezing medication) is injected into the skin. Once the area is numb, the interventional radiologist uses ultrasound or fluoroscopy images to guide the needle into one of the bile ducts. Once the needle is in good position, contrast medium is injected to outline 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 which can be performed through the catheter include balloon dilation of narrowings in the bile ducts, removal of gallstones with a special basket device, and 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.

How does this technique work? What does the radiologist see?

The contrast injections into the bile ducts allow 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. The contrast injection also outlines any gallstones or other abnormal material within the bile ducts. As described above, transhepatic access permits certain types of treatment at the same time or during future procedures.

How will I learn the results?

The interventional radiologist will inform you of what was done and how the procedure went as soon as the procedure is over.

What if I have other questions?

For further information you should contact Children's Interventional Radiology Office at 617-355-6579. The appropriate person will be asked to return your call and answer your questions.


					Children's Hospital Boston is the primary pediatric teaching hospital of Harvard Medical School

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