Diagnosis and Management of Complications from Percutaneous Biliary Tract Interventions

Abstract

Complications related to percutaneous biliary tract interventions (PBTIs) can range from access site discomfort to life-threatening vascular complications. These complications are relatively uncommon, and most of them are self-limiting. However, major complications for which an increased level of patient care and/or a prolonged hospital stay are required and that may lead to death-albeit rarely-can occur. Some of the most common complications related to PBTI include pain, infection, bile leakage, and catheter blockage. These conditions can be easily recognized by using the patient's clinical history and laboratory examination results. However, the more uncommon complications, such as life-threatening hemobilia, acute pancreatitis, and catheter and stent fractures, may have nonspecific clinical manifestations, and the underlying pathologic condition may be found only when it is being sought specifically. It is important that diagnostic and interventional radiologists be aware of the wide spectrum of PBTI-related complications, as early recognition and treatment may prevent catastrophic situations. In addition, knowledge of the different treatment options is essential for guidance in interventional radiology procedures such as transarterial control of hemobilia, imaging-guided direct percutaneous embolization of pseudoaneurysms, and percutaneous treatment of catheter- and stent-related complications such as fractures. The authors review a wide spectrum of complications associated with PBTI and the percutaneous management of these conditions. They also highlight valuable lessons learned from morbidity and mortality rounds at a high-volume tertiary care center. RSNA, 2017.

Percutaneous transhepatic biliary drainage (PTBD) in patients with dilated vs. nondilated bile ducts: technical considerations and complications

“…The most severe complications of PTBD are pancreatitis, hemorrhage, fistulae between the bile duct and hepatic artery or portal vein, pseudoaneurysms, bile leaks, and transpleural punctures with risk of pneumothorax or hematothorax [7][8][9] and occur in 8.6-22% [10,11] of the procedures. PTBD in patients with nondilated bile ducts are described to have a higher complication rate and a lower success rate compared with patients with dilated bile ducts [5,12].…”

Bleeding after Percutaneous Transhepatic Biliary Drainage: Incidence, Causes and Treatments

“…PTBD results in complications in up to 10% of cases, which range from minor (e.g., access site pain) to death [ 9 ]. Nonvascular complications of PTBD include pneumothorax, pleural effusion/empyema, biliary leak into the peritoneum and pancreatitis [ 9 ]. The reported rate of significant bleed after PTBD varies from 0.6% [ 10 ] to 12% [ 11 ].…”

Necrotizing Fasciitis from a Percutaneous Transhepatic Biliary Drainage Site

“…Most abscess-related complications of PTBD are intraperitoneal abscesses, usually caused by ascending infection from the normal flora of the gut. Mortality rates have been reported to range from 0.1% to 0.8% [7]. Extraperitoneal infections usually involve mild to moderate infection of the PTBD insertion site, which are usually treated with empirical intravenous antibiotic administration.…”