Percutaneous Transhepatic Cholangioscopy and Stone Extraction in a Patient with Recurrent Cholangitis Following Liver Trauma

Percutaneous transhepatic cholangioscopy (PTCS) is a safe and effective treatment for obstructive biliary stones, when endoscopic retrograde cholangiopancreatography (ERCP) is unsuccessful or unavailable. Once percutaneous access is gained into the biliary tree by an interventional radiologist, the biliary ducts can be directly visualized and any biliary stones can be managed with lithotripsy, mechanical fragmentation, and/or percutaneous extraction. We report a case of a 45-year-old man who sustained a traumatic liver laceration and associated bile duct injury, complicated by bile duct ectasia and intrahepatic biliary stone formation. Despite undergoing a cholecystectomy, multiple ERCPs, and percutaneous transhepatic cholangiogram with drain placement, the underlying problem was not corrected leading to recurrent bouts of gallstone pancreatitis and cholangitis. He was ultimately referred to an interventional radiologist who extracted the impacted intrahepatic biliary stones that were thought to be causing his recurrent infections through cholangioscopy. This is the first case of PTCS with biliary stone extraction in the setting of recurrent biliary obstruction and cholangitis due to traumatic bile duct injury.

Progression to invasive cancer after snare polypectomy of intracholecystic papillary neoplasms during gallbladder stone removal by percutaneous transhepatic choledochoscopy: a case report

Background Intracholecystic papillary neoplasms (ICPNs) of the gallbladder are rare, preinvasive lesions characterized by an intracholecystic papillary growth that may be associated with invasive adenocarcinoma. The natural history of ICPN is unknown. Here, we report a case of ICPN, highlighting its natural course. Case presentation A 79-year-old woman presented to the emergency department with perforated cholecystitis. After percutaneous transhepatic gallbladder drainage, due to the presence of surgical risk factors, we opted to perform gallstone removal through percutaneous transhepatic cholangioscopy instead of cholecystectomy. ICPN, which was accidentally detected after the removal of the gallbladder stones, was also endoscopically removed. After 4 years, the patient came back to the hospital with a large gallbladder mass. After cholecystectomy, pathological examination revealed ICPN with invasive adenocarcinoma. Conclusion The current case showed endoscopic findings of ICPN and its natural progression, particularly its clinicopathological features and outcomes.

One-step percutaneous transhepatic cholangioscopy combined with high-frequency needle-knife electrotomy in biliary strictures after liver transplantation

Background Endoscopic management is the mainstay for biliary strictures after liver transplantation. However, this method is often failed in cases associated with hepatolithiasis or refractory strictures. The aim of this study is to investigate whether one-step PTC combined with high-frequency needle-knife electrotomy can be an alternative method in biliary strictures after liver transplantation that could not be treated by endoscopic management. Methods Clinical data of 14 patients suffering from biliary strictures after liver transplantation from June 2014 to January 2018 were retrospectively analyzed. One-step PTC combined with high-frequency needle-knife electrotomy was used to resolve the strictures. Results One-step PTC was successfully performed in all 14 patients. In 10 of 12 (83.3%) patients with hepatolithiasis, the stones were removed completely. The stricture resolution was achieved in 13 of 14 (92.9%) patients at supporting catheter removal. Three mild adverse events occurred (cholangitis, 2 patient; delayed hemobilia, 1 patient), but were resolved with conservative treatment. The follow up after supporting catheter removal was 15.7 ± 4.5 months. Only 1 patient (8.3%) had stone recurrence and no stenosis occurred during supporting-free follow-up. Conclusion One-step PTC combined with high-frequency needle-knife electrotomy appears to be a useful for treating biliary strictures after liver transplantation.