A CASE OF BILIARY OBSTRUCTION TREATED BY EXTERNAL BILIARY DUODENAL DRAINAGE

Abstract

A 72-year-old man visited our department with the chief complaint of jaundice. Under the diagnosis of obstructive jaundice, percutaneous transhepatic biliary drainage (PTCD) and percutaneous transhepatic cholangioscopy (PTCS) were performed. Although primary sclerosing cholangitis was suspected, the complication of malignant tumor was also considered. Formation of an internal fistula for PTCD and endoscopic retrograde biliary drainage were impossible because of narrowing of the hepatic duct in the porta hepatis and narrowing of the common bile duct. Percutaneous endoscopic gastrostomy was performed to reduce jaundice by forming an internal fistula according to the method of Shike et al. From the fistula, a catheter 5 mm in diameter was inserted percutaneously through the stomach into the duodenum under endoscopic observation, and the other end of the catheter was extracorporeally anastomosed to the PTCD catheter for external biliary duodenal drainage. When the catheter was placed in an appropriate position in the duodenum, favorable drainage was obtained. Treatment by external biliary duodenal drainage seems to be a useful method of forming an internal fistula. It enables favorable reduction in jaundice by forming an internal fistula, even on an outpatient basis, without causing any severe complications.