In percutaneous transhepatic cholangiography (PTHC), a contrast dye is injected directly into a bile duct in the liver, and a series of x-ray films is taken as the material flows through the biliary system. The dye delineates the biliary tract on the x-ray images and reveals any significant abnormalities. Percutaneous transhepatic cholangiography (PTHC) is usually ordered after less invasive tests, such as CT scanning or ultrasound, fail to provide a definitive diagnosis.

Purpose of the Percutaneous Transhepatic Cholangiography

  • To evaluate the cause of jaundice (yellowing of the skin); in particular, to determine whether impaired bile flow is caused by a bile duct obstruction or nonobstructive liver disease
  • To identify the location and extent of any mechanical obstruction in a bile duct
  • To determine the cause of upper abdominal pain that persists after the gallbladder has been removed

Who Performs Percutaneous Transhepatic Cholangiography

Special Concerns about Percutaneous Transhepatic Cholangiography

  • Endoscopic retrograde cholangiopancreatography is used more frequently than PTHC to visualize the biliary system because it is associated with fewer complications. However, PTHC is the only method that can be used to examine the bile ducts after most gastric surgeries.
  • People with allergies to iodine or shellfish may experience an allergic reaction to the iodine-based contrast dye.
  • Pregnant women should not undergo this test because exposure to ionizing radiation may harm the fetus.
  • This test is not suitable for patients with infection of the bile ducts (cholangitis), a large amount of ascites (excess fluid in the abdomen), or certain bleeding disorders. Blood coagulation studies may be necessary to ensure you are a proper candidate for the test.
  • Severe obesity or the presence of residual barium in the abdomen from recent contrast x-rays of the digestive tract may interfere with visualization of the bile ducts.

Before the Percutaneous Transhepatic Cholangiography

  • Inform your doctor if you have an allergy to anesthetics, x-ray dyes, iodine or shellfish. You may be given a combined antihistamine-steroid preparation to reduce the risk of an allergic reaction, or an alternative noniodinated contrast agent may be used.
  • Do not eat or drink after midnight on the day before the test.
  • You may be asked to take a laxative on the night before the test, and you may receive a cleansing enema on the morning of the test.
  • If necessary, you may receive intravenous antibiotic injections on the day before the test to prevent infection.
  • The doctor may give you a sedative before the procedure.

What You Experience

  • You will lie on your back on an x-ray table. The skin on your right upper abdomen is cleansed with an antiseptic solution, and a local anesthetic is injected to numb the area overlying the liver and the liver itself. You may feel brief discomfort when the needle penetrates the liver.
  • Under the guidance of fluoroscopy, which transmits continuous, moving x-ray images to a viewing screen, the doctor advances a thin, flexible needle through your skin and into the liver. You are instructed to exhale completely and hold your breath as the needle is inserted.
  • When the needle is positioned in a bile duct, contrast dye is injected. You may feel a sensation of abdominal pressure and fullness, as well as transient pain in your upper back on the right side.
  • A series of x-ray films is obtained. At various points, the table may be rotated, and you may be asked to assume several different positions. You must remain perfectly still as the films are taken.
  • After the x-rays are completed, the needle is withdrawn slowly.
  • The procedure takes about 30 to 60 minutes.

Risks and Complications of Percutaneous Transhepatic Cholangiography

  • Some people may experience an allergic reaction to the iodine-based contrast dye, which can cause symptoms such as nausea, vomiting, sneezing, hives, flushing of the skin, sweating, excess saliva and occasionally a life-threatening response called anaphylactic shock. Emergency medications and equipment are kept readily available.
  • Serious risks include peritonitis (infection or inflammation of the membrane lining the abdominal cavity) caused by passage of bile outside of the liver; bleeding caused by unintentional puncture of a large blood vessel in the liver; inflammation of the bile ducts (cholangitis); and blood poisoning (septicemia) or infection (bacteremia).

After the Percutaneous Transhepatic Cholangiography

  • You must remain in bed for at least 6 hours after the test, preferably lying on your right side, to help prevent bleeding (hemorrhage). Pain medication is provided if needed. A sandbag may be placed over the injection site to help control any bleeding.
  • While you recover, your vital signs are monitored periodically, and you will be checked for any signs of complications, such as bleeding or swelling at the injection site, chills, fever, and abdominal pain, tenderness, or distention.
  • You may resume your normal diet and gradually return to your normal activities.

Percutaneous Transhepatic Cholangiography Results

  • The doctor will examine the x-ray films to determine whether the bile ducts are dilated (indicating an obstruction) or normal size (indicating nonobstructive jaundice caused by liver disease). Obstruction can be caused by gallstones, tumors, cysts, inflammation, or stricture (narrowing).
  • If a bile duct obstruction is present, your doctor may recommend treatment, such as insertion of a temporary catheter or stent, to drain the biliary tract.
  • If liver disease is suspected, another test, such as a liver biopsy, may be needed to identify the cause.

Source:

The Johns Hopkins Consumer Guide to Medical Tests

Simeon Margolis, M.D., Ph.D., Medical Editor

Updated by Remedy Health Media

Publication Review By: the Editorial Staff at Healthcommunities.com

Published: 10 Jan 2012

Last Modified: 10 Jan 2012