Another change in technique which we sometimes employed was that once USG puncture was done and flow of bile through the puncture needle was seen, we passed the wire under USG before doing a cholangiogram
to prevent loss of needle access.
An advantage to nasobiliary drainage is that it enables monitoring of bleeding, irrigation of the bile duct, and follow-up cholangiograms
without a need for a repeat endoscopy; the same applies to percutaneous biliary drains [36, 59].
The common exclusion criteria are age more than 70 years, BMI > 35 kg/[m.sup.2], ASA grade 3 or more, complicated biliary disease (evidence of common bile duct stones or previous endoscopic retrograde cholangiogram
, severe pancreatitis, and recurrent admissions with cholecystitis), previous extensive abdominal surgery, or a history of severe postoperative nausea and vomiting [8,26].
Repeat ERCP revealed normal cholangiogram
with no residual stricture in lower CBD, with normal papilla (Figure 2(a)).
In classical primary sclerosing cholangitis (PSC), the stenoses would have been shorter, giving the cholangiogram
a more beaded appearance.
The patient underwent LC, performed by a senior surgical trainee with an intraoperative cholangiogram
showing no filling defects in the biliary ducts and free flow of contrast into the duodenum.
If the patient had a gallbladder present, it was dissected, a cholangiogram
was performed, and it was removed via a standard technique.
Balloon extraction was performed although no definite common duct stone was seen; completion cholangiogram
did not demonstrate a stone or obstruction.
Biliary atresia was diagnosed by intraoperative cholangiogram
or identification of an atretic extrahepatic biliary tree at the time of the Kasai operation.
His suggestions was that one should do intra operative cholangiogram
. While going into the dangerous area, stop and seek help from another surgeon if you think it is difficult for you to manage.
Caption: Figure 6: Occlusion cholangiogram
after cystic duct stone removal.
He underwent ERCP; cholangiogram
showed a CBD stone difficult to be extracted.
Caption: Figure 1: Study patients inclusion breakdown; CBD: Common Bile Duct; PTC: Percutaneous Transcutaneous Cholangiogram
; ERCP: Endoscopic Retrograde Cholangiopancreatography.
was scheduled secondary to concern for biliary atresia.
Magnetic resonance cholangiopancreatography and cholangiogram
revealed biliary obstruction, with intrahepatic biliary duct dilatation, due to the presence of biliary stones in the main bile duct and near the biliary-enteric anastomosis (Figure 1).