Percutaneous Transhepatic Cholangiography (PTHC)

What is percutaneous transhepatic cholangiography?

Percutaneous transhepatic cholangiography (PTHC) is a way to look for something that might be blocking the flow of bile or for other problems in the liver or bile ducts. Bile is a fluid made by the liver and stored in the gallbladder. Bile helps the body digest fats. The bile ducts are the tubes that carry bile from the liver to the gallbladder and small intestines.

To make blockages show up on X-rays, a dye is injected directly into the drainage system of the liver. As the dye moves through the ducts, it can be seen on a TV screen. If there is a blockage, the dye shows where the blockage is. Causes of a blockage may be a gallstone, cancer, or other growth.

When is it done?

There are 2 main procedures for looking at the liver, gallbladder, and bile ducts: PTHC and endoscopic retrograde cholangiopancreatography (ERCP).

ERCP is the test of choice because:

• It is less invasive than PTHC.
• It is less painful than PTHC.

PTHC is used when:

• ERCP will or does not work because the scope used in ERCP cannot be passed into the bile duct system or something is blocking the dye from going into part of the bile duct system.
• You have had surgery that changed your internal anatomy.
• You are being treated for post-operative or post-trauma bile leakage.

How do I prepare for this procedure?

Before the test, be sure to let your healthcare provider know if you:

• Are allergic to anesthetics, X-ray dyes, iodine, or shellfish.
• Are diabetic.
• Take regular doses of aspirin or other nonsteroidal anti-inflammatory drugs, also called NSAIDS.
• Take a blood thinner, such as Coumadin.
• Could be pregnant.

For clear X-ray images, the stomach must be empty. You may be asked not to eat or drink anything after midnight the day of the test, or for at least 8 hours before the test.

What happens during the procedure?

The test is often done at an outpatient clinic. It usually takes 30 minutes to 1 hour.

You will be given a local anesthetic to prevent pain. You will also be given a sedative that will relax you and may put you to sleep. You will lie on your back on a table that tilts. The upper right side of your abdomen will be cleaned and then a long, thin, flexible needle will be inserted through your skin high on the right side of the belly into the liver. Dye will be injected through the needle and into the liver. Your healthcare provider will watch the dye moving through the bile ducts on a TV screen. Still X-rays will also be taken. If a blockage is found, your provider may insert a thin flexible tube, called a catheter. This will allow bile to drain into a bag outside the body or into the small intestine.

What happens after the procedure?

After the test, you will need to rest in bed for at least 6 hours. This is necessary to make sure there is no bleeding from the site of the injection.

Possible side effects of the dye include:

• nausea
• vomiting
• flushing of your skin
• itching
• sweating
• having more saliva than usual.

You may notice soreness for 1 to 2 days at the site where the needle was put into your skin.

What are the benefits of PTHC?

The benefits of PTHC are:

• Your provider can look for stones in the bile system.
• If you have an infection in the bile duct system, it can be drained.
• You can be checked for possible cancer in the bile system.

What are the risks of PTHC?

The risks of PTHC are:

• infection
• pneumothorax (collapsed lung)
• peritonitis (abdominal inflammation or infection)
• sepsis (infection in the blood)
• hemorrhage (bleeding from the procedure).

When should I call my healthcare provider?

Call your provider right away if:

• You have chest pain.
• You have trouble breathing.
• You have a fever or other signs of infection.
• You have bleeding.

Call during office hours if:

• You are having a lot of pain after the procedure.
• You have any other questions or concerns.