Percutaneous Transhepatic Cholangiogram

What is a percutaneous transhepatic cholangiogram?

A percutaneous transhepatic cholangiogram, or PTC, is an X-ray of the bile ducts (also called the biliary ducts). Radiologists and other doctors use the images to determine if the ducts are underdeveloped or blocked. If the ducts are blocked, the doctor may place a drainage catheter. PTC is sometimes performed at the same time as a liver biopsy. Bile is a substance that helps digest fats. It is made in the liver and stored in the gallbladder. After meals, it is excreted into the intestines via the bile ducts.

About this Treatment

About this Treatment

How do we perform a PTC?

Using ultrasound and live X-ray (fluoroscopy) for guidance, the radiologist will insert a small needle through the skin and liver and into one of the bile ducts. Then the radiologist will inject X-ray dye into the ducts and X-ray images will be obtained. Your child will be protected by an X-ray shield during this procedure.

Will my child be awake for the procedure?

No. We will use either IV sedation or general anesthesia so that your child isn’t awake.

Will my child be in any pain?

Your child will not feel pain during the procedure but some patients may feel discomfort around the needle and catheter insertion site for a few days following the procedure.

How long does the procedure take?

The procedure will take approximately one hour. Some children may need to arrive may hours before the procedure to have certain lab tests performed, which will be clearly communicated to you.

What risks are associated with the procedure?

The procedure is considered low-risk. However, potential complications include:

  • Bleeding
  • Infection
  • Injury to the gallbladder
  • Bile leak (biloma)
  • Puncture of the lung (very rare)
  • Allergic reaction to X-ray dye (contrast reaction)

Pre and Post Operative Care

Pre and Post Operative Care

How do my child and I prepare for the procedure?

We encourage good communication between you and your child, including the necessity and overview of the procedure as well as ensuring them that you are close by the whole time. Holding them or their hands until they leave for the procedure is a great way to provide support.

You will be given specific instructions along the way but you may need to arrive a few hours before the scheduled procedure to have some blood tests done. When you arrive at the hospital, a doctor will review the procedure and associated risks, after which you will sign a consent form. When we are ready to get started with the procedure, a nurse will place an intravenous line to deliver sedating medications and you will be allowed to accompany your child in the operating room until they are asleep, after which you will be escorted to a waiting room.

What happens after the procedure?

Nurses will monitor your child in the recovery area for a couple hours for successful recovery from any sedating medications, if any, and any immediate complications. The doctor may decide to have your child admitted to the hospital for an overnight stay. As mentioned, there may be some discomfort around the catheter insertion site for some days following the procedure, which is easily relieved by over-the-counter medications. It is important to keep the bandage surrounding the tube clean and dry.

When can I remove the bandage?

Leave the bandage on for 48 hours. Then you may remove the clear bandage and gauze; do not remove the Steri-Strips® (white strips). If a drainage catheter was placed, it will be secured with a locking device (StatLock®), which must not be removed.

When can my child bathe?

Keep the site completely dry for the first 48 hours. After 48 hours, your child may shower or have a sponge bath, but you should continue to keep the area dry. Do not submerge the site in water (bath or pool) until the Steri-Strips have fallen off.

When can my child resume normal activities like playing?

Your child will be able to resume a normal lifestyle and activity as tolerate within a couple days.

CONTACT CNMC IMMEDIATELY IF YOUR CHILD EXPERIENCES ANY OF THE FOLLOWING:

•     Redness, pain, swelling, or bruising at the needle insertion site.

•     Fever higher than 101o Fahrenheit or 38o Celsius.

The department of Interventional Radiology can be reached at: 202-476-3791, Monday through Friday, between 8 a.m. and 5 p.m.

At all other times please call 202-259-8643, which is the on-call pager. Follow the instructions and wait for a call back.

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