Endoscopic Removal of Remained Drawstring After Percutaneous Transhepatic Biliary Drainage

Tae Wook Yoon; Geun Yong Jung; Young Jun Park; Jun Young Choi; Jee Hwan Jung; Tae Gyoon Kim

doi:10.7180/kmj.2016.31.2.173

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Yoon, Jung, Park, Choi, Jung, and Kim: Endoscopic Removal of Remained Drawstring After Percutaneous Transhepatic Biliary Drainage

Case Report

Kosin Medical Journal 2016;31(2):173-178.

Published online: 20 January 2016

DOI: https://doi.org/10.7180/kmj.2016.31.2.173

Endoscopic Removal of Remained Drawstring After Percutaneous Transhepatic Biliary Drainage

Tae Wook Yoon, Geun Yong Jung, Young Jun Park, Jun Young Choi, Jee Hwan Jung, Tae Gyoon Kim

Department of Internal Medicine, VHM Medical center, Seoul, Korea

Corresponding Author: Tae Gyoon Kim, Department of Internal Medicine, VHM Medical center, 53, Jihwangdo-ro 61-gil, Gangdong-gu, Seoul 05368, Korea Tel: +82-2-2225-1114 Fax: +82-2-2225-4374 Email: gyoondle@hanmail.net

Received 23 June 20152 September 2015 Accepted 16 September 2015

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

The percutaneous transhepatic biliary drainage (PTBD) is an effective intervention as a palliative therapy for relieving a jaundice and cholangitis. It may be used in place of Endoscopic retrograde cholangiopancreatography (ERCP) in the obstructive biliary disease. Recently, by developing invasive procedures, the incidence of the complications such as bleeding and perforation has been increasing in the diagnosis and treatment of hepatobiliary disease. We report here on a case of remained drawstring after PTBD in a 85-year-old man. The patient was conducted PTBD for relieving a jaundice and cholangitis. And then the patient had complained of abdominal pain constantly. A few days later, we removed PTBD and attempted ERCP for removal of CBD stone. The ERCP showed remained drawstring around ampulla of vater and we removed it by IT knife. The drawstring was successfully removed.

Keywords: Acute cholangitis, Endoscopic retrograde cholangiopancreatography (ERCP), Percutaneous transhepatic biliary drainage (PTBD)

References

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Fig. 1.

Black arrow in abdomen CT demonstrating 9mm sized biliary stone in the distal common bile duct.

Fig. 2–1.

Endoscopy showed an ampulla of vater tightened by a remained drawstring after removing percutaneous transhepatic biliary drainage. Fig. 2–2. Endoscopy showed an ampulla of vater after removing a remained drawstring. Fig. 2–3. The remained drawstring to prevent a drainage tube from falling into the body.

Fig. 3.

The twisted biliary tube on the duodenum.

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