Percutaneous Transhepatic Transtumoral Biliary Drainage in a Patient with Obstructive Jaundice due to Klatskin Tumor

Abstract

Although the endoscopic retrograde biliary drainage(ERBD) is the preferred palliative treatment for unresectable mlignant obstructive jaundice, the failure of endaprosthesis insertion occurs in 15% of the cases. Espeeially in hilar malignancy, the failure results from the inability to pass ei~ther a guide wire or a stent due to biliary stenosis or obstruction by tumorous extension. In such caae, percutaneous transhepatic biliery drainage(PTBD) can be achieved. When the tumor extends into the hilum, isolating the right and left hepatic ducts, drainage of unilateral hepatic duct will usually provide adequate palliation. However, when patients have contralateral cholangitis or jaundice fails to resolve with unilateral biliary drainage, bilateral drainage may be necessary. Compared to ERBD, the method of prolonged external biliary drainage has unwanted disadvantages. In order to achieve internal biliary drainage in case with complete obstruction of hepatic ducts due to tumor extension, percutaneous transhepatic transtumoral biliary drainage(PTTBD) could be considered. We report a case with obstructive jaundice and cholangitis due to complete obstruction of right hepatic duct and stenosis of common hepatic duct from Klatskin tumor, which was sucessfully managed by internal biliary drainage with transtumoral biliary stenting under the guidance of computed tomography. (Korean J Gastrointest Endosc 16: 517~ 523, 1996)