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A transhepatic (through the liver) cholangiogram is an invasive imaging study that involves placement of a needle and possibly a catheter directly through the skin into one of the bile ducts in the liver. The Division of Interventional Radiology uses ultrasound and x-rays to guide the placement of the needle and catheter.
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.
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.
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.
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.
You will be instructed by the day surgery nurse or at the time of your pre-op visit
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.
Three possible therapeutic options which can be performed through the catheter at the same time or during future procedures include:
Alternatively, the radiologist may decide to leave a special soft catheter in place to continue draining the bile.
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.
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.
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