PROCEDURES:  

  1. Cholangiography through existing drainage catheter
  2. Biliary drain removal

 

INDICATION: History of cholecystectomy and gastric bypass with postoperative choledocholithiasis.   Status post percutaneous stone sweeping and cholangioplasty complicated by hepatic artery pseudoaneurysm status post coil embolization. Presents today for cholangiogram and possible anchor removal if passes Whitaker test.

 

OPERATORS:   John Doe, MD (Attending)/Jane Doe, MD (Fellow)     

MEDICATIONS: Versed 3 mg IV, Fentanyl 300 mcg IV, Zosyn 3.375 mg IV, 4 mg Zosyn IV

CATHETER: Existing 14 French Amplatz anchor             

 

PROCEDURE: 

The risks, benefits and alternatives to the procedure and sedation were explained to the patient, and written informed consent obtained. 

The right abdomen was prepped and draped in the usual sterile fashion. 2% Lidocaine was injected in the subcutaneous and deep soft tissues around the existing drain. 

The power injector was set up for performance of the Whitaker test. The dilution of normal saline:contrast was 3:1 (150 cc NS, 50 cc nonionic contrast). Contrast was injected slowly and measurements taken as follows:

2cc/min,  total time 5 minutes,  10 cc volume,  Pressure 9 mmHg

4cc/min,  total time 5 minutes,  20 cc volume,  Pressure 10 mmHg

8cc/min,  total time 5 minutes,  40 cc volume,  Pressure 10 mmHg

15cc/min,  total time 3 minutes,  45 cc volume,  Pressure 10 mmHg

20cc/min,  total time 2 minutes,  40 cc volume,  Pressure 10 mmHg

 

Fluoroscopic images were obtained at each pressure measurement.  The Amplatz anchor was unlocked and removed. Final scout image was obtained. Sterile dressing was applied.

The patient tolerated the procedure well and was discharged from the angiography suite  in satisfactory condition.

 

FINDINGS:

Cholangiographic images during the Whitaker test demonstrates dilated common bile duct without evidence of filling of the biliary tree. Contrast is seen moving antegrade into small bowel. No leakage at tube insertion site. Pressure measurements demonstrate successful passing of the Whitaker test with pressure differential remaining < 20 mm Hg. Amplatz anchor removed. 

 

IMPRESSION:

  1. Successful Whitaker test and removal of Amplatz anchor.