What Is Percutaneous Transhepatic Biliary Drainage?

In percutaneous transhepatic biliary drainage a small, flexible, plastic tube is placed through the skin into the liver to drain a blocked bile duct system.

Percutaneous transhepatic biliary drainage or percutaneous transhepatic cholangiodrainage (PTCD) is a procedure to drain bile to relieve pressure in the bile ducts caused by a blockage. 

The liver makes bile which helps in digestion of the fats. The bile passes through a series of small tubes (called ducts) that drain into a large duct, called the common bile duct. The common bile duct empties into the first part of the small bowel (duodenum). The bile produced in the liver is also stored in the gallbladder.   

If the bile duct(s) gets blocked, the bile cannot drain normally and gets collected before to the site of the blockage. The signs of blocked bile ducts are jaundice (yellowing of the skin and white of the eye), dark urine, light- or clay-colored stools, itching, nausea, and loss of appetite. This condition is potentially serious and needs to be treated.   

In percutaneous transhepatic biliary drainage a small, flexible, plastic tube is placed through the skin into the liver to drain a blocked bile duct system. Ultrasound and x-ray of the abdomen locate the blockage of bile flow. Thereafter, the images made by ultrasound guide the placement of small plastic or metal tube (stent) in the liver to drain bile. The bile drains via the stent into the small bowel or in a collection bag outside the body. This procedure may relieve the obstruction symptoms before surgery is done.

The commonest indication for percutaneous biliary drainage (PBD) is blockage or abnormal narrowing (stricture) of the bile ducts. Many conditions can cause this, including:

• Gallstones (stones in the gallbladder or within the bile ducts)
• Tumors of the bile ducts, liver, gallbladder or pancreas
• Pancreatitis (inflammation of the pancreas)
• Sclerosing cholangitis (a type of inflammation of the bile ducts)
• Enlarged lymph nodes in the region of the liver and pancreas
• Postoperative strictures (narrowing of the bile ducts or perforation due to injury to the bile ducts during surgery)
• Perforation 
• Infection

Percutaneous biliary drainage provides an alternative pathway to the bile to exit the liver. The drainage may be needed in preparation for surgery or other procedures on the bile ducts, such as removal of a bile duct stone or tumor.

PBD should, however, be avoided if there is:

• Massive ascites (excessive collection of fluid in the abdomen)
• Multiple obstructions within the liver
• Bleeding disorders

The complications of the procedure may include:

• Bile leakage
• Hemobilia (bleeding from or into the biliary tree)
• Cholangitis (inflammation of the bile ducts)
• Hemothorax (collection of blood between the chest wall and the lungs)
• Pancreatitis
• Infection

The duration for which you will have the drainage bag attached varies, so your treating doctor can best answer this question. You must learn to take care of the biliary drainage bag. Avoid making any sudden movements and make sure that the drainage bag can move freely with you.  You will be able to lead a fairly normal life with the drainage bag. The bag, however, needs to be emptied frequently so that it does not become too heavy.