Pamela H. Haskin

Interventional radiology of the biliary system and pancreas

In recent years, newer techniques have become available to the clinician for the diagnosis and treatment of biliary and pancreatic disease. This article emphasizes interventional procedures through the liver, such as percutaneous transhepatic cholangiography, percutaneous transhepatic biliary drainage, and ancillary techniques. Also discussed are the nonsurgical management of bile duct calculi and the diagnosis and treatment of pancreatic tumors, abscesses, and pseudocysts.

Percutaneous cholecystostomy in patient at high risk: Treatment of acute acalculous cholecystitis

Percutaneous cholecystostomy can be a useful technique for the ill, elderly, or high-risk patient, since he or she is spared open surgery. We used it successfully in a medically unstable woman with acute acalculous cholecystitis. Her drainage catheter, often the source of complications with the procedure, may have been removed too early: A small asymptomatic subdiaphragmatic fluid collection and ileus developed. However, both resolved in 48 hours.

Management of obstructed biliary endoprostheses

In five patients with bile duct obstruction, a previously inserted endoprosthesis became occluded. After repeat percutaneous biliary drainage, the prostheses were mechanically unclogged, removed, or removed and replaced. No patient required surgery, and no prosthesis reoccluded. We discuss technique for deoccluding and, if necessary, removing and replacing obstructed stents.

Solution to a knotty biliary drainage problem

The standard technique for percutaneous transhepatic biliary drainage in our institution and as described in the literature is successive dilatation of the liver tract and biliary system with tapered-tipped dilators until the proper drainage catheter can be inserted (Teplick et al, 1984). We report a case in which the guide-wire became knotted in the duodenum and could not be removed through the standard catheters or tapered-tipped dilators.

The Diagnostic Imaging Information Center

The authors have developed a Diagnostic Radiology Imaging Information Center, in which the physician can see at a glance, with minimum expenditure of time and maximum emphasis on relevance, a summary of the patients studies and procedures done in the x-ray department.