Percutaneous Transhepatic Cholangiography (PTC)

Percutaneous Transhepatic Cholangiography (PTC)

(PTC )Showing dilated biliary ducts

Percutaneous Transhepatic Cholangiography (PTC) is another technique done for preoperative radiologic examination of the biliary tract. This technique is used for patients with jaundice when the ductal system has been revealed to be dilated by computed tomography (CT Imaging) or ultrasonography but the cause of the obstruction is not clear. The routine of this procedure has greatly improved because of the availability of needed medium, the Chiba or Skinny Needle. In addition, PTC is frequently used to place a drainage catheter for the treatment of obstructive jaundice. When a drainage techniques are done at the same time.

Percutaneous Transhepatic Cholangiogram (PTC) Position

Is performed by letting the patient lye on the radiographic table in the supine position. The right side of patient is surgically set and appropriately draped. After a local anesthetic is introduced, the chiba needle is held parallel to the floor and inserted through the right lateral intercostal space and advanced in the direction of the liver hilum. The slylet of the chiba needle is inhibited, and a syringe filled with contrast medium is attached to the needle. Under fluoroscopic control, the needle is slowly withdrawn until the contrast medium is visible and filled in the biliary tree and readily located because the ducts are usually dilated. Once the biliary ducts are filled, the needle is totally withdrawn and serial or spot films in AP projection of the biliary area are generally taken.

Obstruction of Stone on Ampulla

 

 Biliary Drainage Procedure and Stone Extraction

If dilated biliary ducts are identified by Computed Tomography, Percutaneous Tranhepatic Cholangiogram (PTC) or Ultrasonography, the radiologist, after consultation with the referring physician, may elect to place a dranage catheter in the biliary ducts. A needle larger than the Chiba needle used in the PTC procedure is inserted through the lateral abdominal wall and into the biliary duct. A guide wire is the passed through the lumen of the needle, and the needle is removed. Once the catheter is passed over the guide wire, the wire is then removed, leaving the catheter in place.
The catheter can be left in place for prolonged drainage, or it can be used for attemps to extract retained stones are extracted using a wire basket and a small balloon catheter under fluoroscopic control. This extraction procedure is usually attempted after the catheter has been in place for some time.