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Percutaneous transhepatic biliary drainage catheter fracture: 
A case report

Ann Hepatobiliary Pancreat Surg 2018 Aug;22(3):282-6
Published online August 31, 2018
Copyright © 2018 Ann Hepatobiliary Pancreat Surg.

Jia Rui Kwan1, Keith Sheng Hng Low2, Rahul Lohan3, Vishal G Shelat4

1Lee Kong Chian School of Medicine, Nanyang Technological University, 
2Yong Loo Lin School of Medicine, National University of Singapore, Departments of 
3Radiology and 4General Surgery, Khoo Teck Puat Hospital, Singapore
Received November 19, 2017; Revised February 11, 2018; Accepted February 16, 2018.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
 Abstract
Percutaneous transhepatic biliary drainage (PTBD) is safe treatment for biliary decompression given certain indications. However, this is temporary until definitive drainage is established. We report on a 76-year-old lady with recurrent pyogenic cholangitis and PTBD catheter fracture. She had hepatitis B virus-related Child-Pugh class A liver cirrhosis, hypothyroidism, hyperlipidaemia, and previous atrial fibrillation with a background of mild mitral, tricuspid and aortic valvular regurgitation. She had history of laparoscopic cholecystectomy in the past. She was deemed to be a high operative risk and declined hepatic resection. She had undergone multiple endoscopic and percutaneous biliary interventions to control sepsis and stone burden. A bilateral PTBD catheter was left in situ with plans for 3-monthly change. However, she defaulted follow-up and presented 11 months later with complaints of pain over the drain site and inability to flush the right catheter. Abdominal X-ray and computed tomography scans detected right catheter fracture at two places, making three fragments. She underwent percutaneous removal of the proximal fragment by an interventional radiology team. A temporary 4 Fr catheter was inserted to maintain biliary access. Endoscopic removal of the intra-biliary fragments was done the next day. Complete removal was confirmed on fluoroscopy. Finally, the 4 Fr catheter was replaced by a new 12 Fr catheter. The patient was discharged well.
Keywords : Biliary drainage; Catheter fracture; Cholangitis

 

August 2018, 22 (3)