Fluoroscopic control of gallbladder drains

Author: Mikael Häggström

Percutaneous drainage catheter (yellow arrow). In this control, the instilled radiocontrast is filling out the gallbladder (red arrow), where the filling defects are gallstones. The cystic duct (blue arrow) is tortuous, the common bile duct (green arrow) is mildly dilated but patent, with tapering at ampulla Vateri (white arrow), but without obstruction. Contrast is seen extending into the duodenum (orange arrows), demonstrating open passage through the bile ducts.

Procedure

• Take an initial anteroposterior image including the presumed locations of the gallbladder and common bile duct.
• Inject iodinated contrast, usually amounting to approximately 5g of iodine (or about 20 ml of concentration 240mg/ml, but can possibly be multiple times more), and note the following:

• Location of the tip of the drain in relation to the gallbladder
• Flow into the duodenum, or most distal part reached.
• Any visible dilatation of the gallbladder or biliary tract
• Any contrast outside the drain or biliary tract, including leakage along the outside of the drain.
• Any visible stones in the gallbladder or bile duct

If unable to inject any contrast

• Check if there are any kinks of the catheter, visually outside the skin, and/or by radiography inside. Internal kinks can possibly be overcome by switching patient position such as changing from lying down to standing.

Drain malposition

If the drain is partially pulled out, it may be pushed into place, preferably with a hydrophilic guidewire.

Report

At least:

• Drain location
• Most distal part reached by contrast.

Preferably note whether the images indicate an obstruction or open passage (to the duodenum).

See also: General notes on reporting