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February 17, 1984

Bile Leakage After Fracture of a Percutaneous Transhepatic Biliary Drainage Catheter

Author Affiliations

The University of Iowa Hospitals and Clinics Iowa City

JAMA. 1984;251(7):892. doi:10.1001/jama.1984.03340310014010

To the Editor.—  Percutaneous transhepatic biliary drainage (PTBD) has recently gained popularity in the management of obstructive jaundice. Nevertheless, it is not without complication. Fracture of the PTBD catheter can occur and result in massive bile peritonitis.

Report of a Case.—  An 86-year-old woman was admitted to the hospital for extrahepatic ductal obstruction. Laboratory studies disclosed the following values: serum alkaline phosphatase, 350 units/dL; SGOT, 194 units; SGOT, 232 units; total bilirubin, 20 mg; serum amylase, 422 units/L; aspartate aminotransferase, 90 IU; total protein, 5.7 g; albumin, 1.7 g; serum calcium, 5.1 mg; WBCs, 12,200/cu mm; and hematocrit, 27%. Guaiac-positive stools were present. Under antibiotic coverage, she underwent percutaneous transhepatic cholangiography and insertion of 7F catheter (Cook pigtail catheter) for biliary drainage. Within 24 hours, the bilirubin level decreased to 14.6 mg/mL. Two days later, bile drainage decreased suddenly to 500 ml/24 hr, while the total bilirubin level increased to