Percutaneous transhepatic cholangiodrainage after hepatic portoenterostomy for biliary atresia.

During the past 12 mo, percutaneous transhepatic cholangiodrainage (PTCD) was carried out in 9 infants (12 procedures) who had undergone hepatic portoenterostomy (8) and hepatic portocholecystostomy (1) for biliary atresia. Bile excretion following surgery was observed in all infants. In all patients, cholangiogram at the initiation of PTCD was successful in visualizing the intrahepatic biliary system. PTCD was achieved in 5 infants (9 procedures). In infants with cholangitis, cultures of the intrahepatic bile were positive for enteric flora. Direct administration of antibiotics via the PTCD catheter into the bile ducts was transiently effective in the management of cholangitis. In one patient, it was observed that continuous PTCD over three weeks was effective in reducing serum bilirubin by relief of cholestasis. This technique is useful for: (1) demonstration of the reconstructed biliary system, (2) collection of bile from the intrahepatic biliary system for biochemical and bacteriologic studies, (3) direct administration of antibiotics to the bile ducts for cholangitis and (4) decompression of the intrahepatic system and relief of biliary stasis.