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Case Reports
. 2023 Jun 27;15(6):1211-1215.
doi: 10.4240/wjgs.v15.i6.1211.

Percutaneous transhepatic cholangial drainage-guided methylene blue for fistulotomy using dual-knife for bile duct intubation: A case report

Bing-Xi Tang  1 , Xin-Li Li  2 , Ning Wei  1 , Tao Tao  3
Affiliations
Case Reports

Percutaneous transhepatic cholangial drainage-guided methylene blue for fistulotomy using dual-knife for bile duct intubation: A case report

Bing-Xi Tang et al. World J Gastrointest Surg. .

Abstract

Background: Difficult bile duct intubation is a big challenge for endoscopists during endoscopic retrograde cholangiopancreatography (ERCP) procedure. We report a case of percutaneous transhepatic cholangial drainage (PTCD)-guided methylene blue for fistulotomy using dual-knife for bile duct intubation.

Case summary: A 50-year-old male patient had developed obstructive jaundice, and ERCP procedure need to be performed to treat the obstructive jaundice. But intubation cannot be performed if the duodenal papilla cannot be identified because of previous surgery for a perforated descending duodenal diverticulum. We used PTCD-guided methylene blue to identify the intramural common bile duct before dual-knife fistulotomy, and bile duct intubation was successfully completed.

Conclusion: The method that combing methylene blue and dual-knife fistulotomy to achieve bile duct intubation during difficult ERCP is safe and effective.

Keywords: Bile duct intubation; Case report; Endoscopic retrograde cholangiopancreatography; Methylene blue; Percutaneous transhepatic cholangial drainage.

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Conflict of interest statement

Conflict-of-interest statement: The authors declare that they have no conflict of interest.

Figures

Figure 1
Figure 1
Transcholecystostomy imaging showing slight common bile duct dilation.
Figure 2
Figure 2
Treatment. A: Repeated failed attempts to identify the duodenal papilla, a small amount of contrast agent entered the duodenum; B and C: Repeated attempts at guidewire insertion through the percutaneous transhepatic cholangial drainage (PTCD) tube failed; D: mixture of ioversol and methylene blue was injected via the PTCD tube; E: Dual-knife was used for layer-by-layer resection. Pale blue-colored protrusions, which were considered to be the intramural common bile duct, can be seen at the duodenal scar; F: A large amount of methylene blue flowed out after dual-knife resection; G: Common bile duct dilation was observed on endoscopic retrograde cholangiopancreatography imaging; H: Insertion of an 8.5 Fr × 5.0 cm plastic stent; I: A large amount of ioversol and methylene can be seen flowing out.
See this image and copyright information in PMC

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