Abstract:

Article presents a case report of successful antegrade x-ray surgical access to the biliary tree ir order to eliminate partial clipping of the common bile duct as a complication of endoscopic cholecystectomy

Percutaneous transhepatic puncture of the unexpanded biliary tree was made under ultrasounc control without auxiliary contrast enhancement of the bile tree. After punction - antegrade cholangiography revealed partial clipping of common bile duct. Patient underwent balloon dilatation, internal-external transpapillaty drainage. Three-times balloon dilatation after each 2 months made it possible to avoid the formation of posttraumatic stricture and the long-frame external-internal drainage of the biliary tree.

The use of antegrade percutaneous transhepatic access to restore adequate passage of bile to the duodenum, including cases without dissection of the papilla, is advisable in clinical situations that do not allow the use of retrograde endoscopic access, or if it is ineffective. 

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Abstract:

Aim: was to determine indications for transpapillary external-internal drainage of the biliary tree in benign diseases of the peripapillary region.

Material and methods: results of the use of externally-internally transpapillary drainage of the biliary tree from 256 patients with distal obstruction of the biliary tract were analyzed. In 154 (60,2%) cases the peripapillary obstruction was caused by tumor pathology, in 102(39,8%) cases (39.8 %) - by peripapillary benign stenotic diseases (stenosis of Vater papilla, choledocholithiasis, chronic pancreatitis, parapapillary diverticula) that have not managed to eliminate with the help of endoscopy or endoscopic benefit was initially ineffective.

Results: endoscopic papillosphincterotomy after the external-internal drainage due to syndrome of Vater papilla «acute blockage» required in 7(4,5%) patients of 154 patients with peripapillary tumor obstruction. Endoscopic papillotomy was performed in 80(78,4%) patients among 102 patients with benign distal block of common biliary duct after the external-internal drainage for same indications. In 7 cases of «acute blockage» of papilla we were forced to return to the outside cholangiostomy due to endoscopic unattainable of papilla. In summary, the syndrome of papilla «acute blockage» occurred in 87(85,3%) patients with transpapillary external- internal drainage of the biliary tree on the background of the peripapillary benign obstruction. There were no complications of papillotomy

Conclusion: the external-internal drainage of the biliary tree with the syndrome of obstructive jaundice remains an effective and pragmatic method of return of bile into the lumen of the duodenum. The most common complication of the external-internal drainage with transpapillary drainage placement is a syndrome of «acute blockage» of Vater papilla which requires endoscopic papillotomy With high frequency this syndrome occurs when forced transpapillary the external-internal drainage of the distal benign disorders of patency of the biliary tree. Minimal risk of this syndrome developing has been reported during transpapillary drainage in patients with obstructive jaundice due to peripapillary cancer.

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