title: Percutaneous transhepatic sphincterotomy in the management of biliary tract disease.
abstract: This report describes a novel modification of existing transhepatic techniques and illustrates successful relief of mechanical obstructive jaundice in 2 patients in whom surgical or endoscopic intervention was contraindicated or impossible. In each, percutaneous transhepatic cholangiogram (PTC) was performed in the usual manner. A standard endoscopic papillotome was then advanced across the stricture into the duodenum. Sphincterotomy was performed at the 11 to 1 o'clock position using blended current for 3-4 seconds. Repeat cholangiography showed successful decompression of the biliary tree in both patients. No morbidity or mortality was directly attributable to percutaneous transhepatic sphincterotomy in these patients. This technique offers a safe and therapeutic alternative to biliary tract obstruction, and should be considered in selected patients who are not candidates for surgery or endoscopy.
mesh_terms: D000368:Aged; D014670:Ampulla of Vater / Q000601:surgery*; D002779:Cholestasis / Q000000981:diagnostic imaging / Q000601:surgery*; D004322:Drainage; D004378:Duodenal Diseases / Q000175:diagnosis; D004724:Endoscopy / Q000379:methods; D005260:Female; D006801:Humans; D007412:Intestinal Fistula / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D011859:Radiography; D009803:Sphincter of Oddi / Q000601:surgery*