Fine Needle Percutaneous Transhepatic Cholangiography in the Investigation of Cholestasis in Infancy By R. Nelson,
A. N. Hamlyn,
CASE
and
I. Lavelle
REPORT
A male infant with a birth weight of 3.6 kg had cholestaticjaundice since the age of 2 wk. At the age of 5 mo. percutaneous natal hepatitis. eliminated
with abnormal
The known infective and metabolic causes of the neonatal hepatitis
by specitic investigations.
clinical or biochemical improvement. under general anesthetic.
Three
months
Percutaneous
liver function
liver biopsy favored the diagnosis
treatment
with cholestyramine
transhepatlc
cholangiography
using the fine needle technique of Okuda.’
of nro-
syndrome
were
produced no was performed
In this procedure, a long 2.1
gauge Chiba needle is introduced
across the width of the right lobe of the liver by an intercostal
approach. Radioopaque
medium
duct is entered. By this
contrast
is injected while the needle is withdrawn
means a patent extrahepatic
flow of radioopaque dye into the duodenum
(Fig.
until
bile duct system was demonstrated I). Mechanical obstruction
a bile
with free
of the extrahepatic
bile duct svstem was excluded.
Fig. bile
1.
A
duct
opaque upper
patent
extrahepotic
visualized, medium
small
with present
From the Deparmmt
lowno/
of Pediuiric.~.
ropes/s
Queen Victoria
c 1977
the
intestine.
.Addre.t.7 reprinr firmary.
radioin
Royal
10 R. A r/son.
Road. Newcaslle
hv Grune & Strarton.
Inc. lSSN
C’icloria
Irzfirnrarv.
M. R. C‘. P. C‘on.sultanl
lYeu~za.srle C’pon Tyne. England. Paedia/rician.
Roval
C’ic’forla
In-
Upon Tvne. NE I. England 0022-346X.
of Pediofrrc Surgery, Vol. 12, No. 5 (October), 1977
727
728
NELSON,
HAMLYN,
AND LAVELLE
COMMENT
In infants with persistent severe cholestasis, cholangiography is probably required to reliably define those patients who have extrahepatic bile duct obstruction. This has usually required an exploratory laparotomy. In the infant reported, an unnecessary and potentially harmful laparotomy? was prevented by demonstration of a patent extrahepatic bile duct system by percutaneous cholangiography. Transhepatic cholangiography using the tine Chiba needle has been a safe procedure in adults. with little risk of intraperitoneal bile leakage,-l and its use appears eminently suitable to investigate the primary cause of persistent severe cholestasis in infancy. REFERENCES I.
Okuda
Nonsurgical angiography~ cal problems 1974 2. Thaler
K, Tenikewe K, Emure T, et al: percutaneous transhepatic choldiagnostic significance in mediof the liver. Am J Dig Dis I9:21,
MM. Gellis SS: Studies
in neonatal
hepatitis and biliary atresia. Am J Dis Child 116257. 1968 3. Elias h. Hamlyn AN, Jain S, et al: A randomised trial of percutaneous transhepatic cholanpiography vs endoscopic retrograde cholangiography for bile duct visualisation in cholcstasis. Gut 16:X3 I. I975
A. N. Hamlyn,
CASE
and
I. Lavelle
REPORT
A male infant with a birth weight of 3.6 kg had cholestaticjaundice since the age of 2 wk. At the age of 5 mo. percutaneous natal hepatitis. eliminated
with abnormal
The known infective and metabolic causes of the neonatal hepatitis
by specitic investigations.
clinical or biochemical improvement. under general anesthetic.
Three
months
Percutaneous
liver function
liver biopsy favored the diagnosis
treatment
with cholestyramine
transhepatlc
cholangiography
using the fine needle technique of Okuda.’
of nro-
syndrome
were
produced no was performed
In this procedure, a long 2.1
gauge Chiba needle is introduced
across the width of the right lobe of the liver by an intercostal
approach. Radioopaque
medium
duct is entered. By this
contrast
is injected while the needle is withdrawn
means a patent extrahepatic
flow of radioopaque dye into the duodenum
(Fig.
until
bile duct system was demonstrated I). Mechanical obstruction
a bile
with free
of the extrahepatic
bile duct svstem was excluded.
Fig. bile
1.
A
duct
opaque upper
patent
extrahepotic
visualized, medium
small
with present
From the Deparmmt
lowno/
of Pediuiric.~.
ropes/s
Queen Victoria
c 1977
the
intestine.
.Addre.t.7 reprinr firmary.
radioin
Royal
10 R. A r/son.
Road. Newcaslle
hv Grune & Strarton.
Inc. lSSN
C’icloria
Irzfirnrarv.
M. R. C‘. P. C‘on.sultanl
lYeu~za.srle C’pon Tyne. England. Paedia/rician.
Roval
C’ic’forla
In-
Upon Tvne. NE I. England 0022-346X.
of Pediofrrc Surgery, Vol. 12, No. 5 (October), 1977
727
728
NELSON,
HAMLYN,
AND LAVELLE
COMMENT
In infants with persistent severe cholestasis, cholangiography is probably required to reliably define those patients who have extrahepatic bile duct obstruction. This has usually required an exploratory laparotomy. In the infant reported, an unnecessary and potentially harmful laparotomy? was prevented by demonstration of a patent extrahepatic bile duct system by percutaneous cholangiography. Transhepatic cholangiography using the tine Chiba needle has been a safe procedure in adults. with little risk of intraperitoneal bile leakage,-l and its use appears eminently suitable to investigate the primary cause of persistent severe cholestasis in infancy. REFERENCES I.
Okuda
Nonsurgical angiography~ cal problems 1974 2. Thaler
K, Tenikewe K, Emure T, et al: percutaneous transhepatic choldiagnostic significance in mediof the liver. Am J Dig Dis I9:21,
MM. Gellis SS: Studies
in neonatal
hepatitis and biliary atresia. Am J Dis Child 116257. 1968 3. Elias h. Hamlyn AN, Jain S, et al: A randomised trial of percutaneous transhepatic cholanpiography vs endoscopic retrograde cholangiography for bile duct visualisation in cholcstasis. Gut 16:X3 I. I975
