Successful Percutaneous Transhepatic Internal Biliary Drainage with Double Monorail Technique: A Case Report

Background: A 71-year-old woman underwent left hepatectomy for intraductal papillary neoplasm of the bile duct. A hilar abscess occurred and US-guided drainage was performed. After drainage, intrahepatic bile duct was dilated due to inflammation of the abscess. Results: Percutaneous transhepatic biliary drainage (PTBD) was performed for both anterior and posterior branch of the bile ducts. Each bile duct was connected to the abscess cavity; however, because common bile duct (CBD) was not identified, cannulation to CBD was impossible. In combination with endoscopic retrograde approach, the drainage tube in the anterior branch was able to reach CBD, but the tube in the posterior branch was not. To address this issue, double monorail technique was used and the posterior tube was able to reach CBD. Discussions: When performing internal–external transhepatic biliary drainage, there are cases where cannulation of CBD is difficult due to inflammation, traumatic change, or tumors. In such cases, endoscopic retrograde cannulation of intrahepatic bile duct is commonly performed but often fails. In some cases, double monorail technique can be an alternative and effective method, and this is the first report of double monorail technique applied in PTBD. Take Home Points: This technique is used to connect space B and C where connections between space A and B and between space A and C are both established. A very few cases are reported with this technique, and they are limited only to pancreatic fistula. Our case report indicates the effectiveness of the technique in various fields including PTBD.

Publication History

Article published online:
26 April 2021