Year 2017 Vol. 25 No 6




BME Kursk Regional Clinical Hospital 1,
FSBEE HE Kursk State Medical University 2, Kursk
The Russian Federation

Objective. To present the own experience of removing foreign bodies from the biliary tree while performing mini-invasive antegrade endobiliary interventions.
Methods. We observed 11 patients with endobiliary foreign bodies (fragments of a 0.035 metal conductor, 5 Fr manipulation catheter, 10 Fr endobiliary drainage, 9 mm self-expanding stent, incorrectly installed self-expanding 10 mm stent, blocked uncoated self-expanding stent 8 mm), that were caught in the bile ducts during the antegrade transhepatic mini-invasive X-ray surgical interventions. Foreign bodies entered the biliary ducts directly during transhepatic cholangiostomy, as well as during manipulations performed after the initial drainage (drainage replacement, endobiliary stenting).
Foreign bodies were removed by antegrade access. Manipulations were carried out through the lumen of the vascular introducer 6-10Fr, established instead of the cholangiostomical drainage. Percutaneous transhepatic access with a diameter of 28 Fr was used to extract self-expanding stents; in one case a retrograde endoscopic access was used.
Results. Antegrade transhepatic access successfully removed 10 of 11 foreign bodies. Fragments of conductors and manipulative catheters were extracted with endoscopic forceps and an endoscopic basket through the lumen of the commensurate introducer. The drainage fragment was removed by antegrade asses by endoscopic forceps after fixing it to the end face of the introducer 10 Fr. An incorrectly installed self-expanding stent, as well as 2 irreversibly blocked stents, were removed by antegrade transhepatic access under visual control after telescopic dilatation of the puncture canal into the gall-tree to 28 Fr. One fragmented, self-expanding, covered stent was removed endoscopically. There were no complications related to the creation of access for the extraction of foreign bodies, as well as to the technique of their extraction.
Conclusions. Minimally invasive percutaneous transhepatic access seems to be an alternative to open surgical access to the gall-tree in case of extracting of large foreign bodies, in particular - irreversibly blocked endobiliary stents.

Keywords: biliary tract, foreign bodies, antegradecholangiostomy, endobiliary stent, endobiliary interventions
p. 662-668 of the original issue
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Address for correspondence:
305007, Russian Federation,
Kursk, Sumskaya str., 45-a,
BME Kursk Regional Clinical Hospital,
Unit of X-ray Surgical Methods
of Diagnosis and Treatment 2,
tel.: +7 4712 35-93-30
e-mail: oleg_okhotnikov@,
Oleg I. Okhotnikov
Information about the authors:
Okhotnikov O.I., MD, Professor, Head of the Unit of X-ray Surgical Methods of Diagnosis and Treatment 2 of BME Kursk Regional Clinical Hospital, Professor of the Department of Radiation Diagnostics and Therapy of FSBEE HE Kursk State Medical University.
Yakovleva M.V., PhD, Associate Professor of the Department of Surgical Diseases of FSBEE HE Kursk State Medical University, Physician of the Unit of X-ray Surgical Methods of Diagnosis and Treatment 2 of BME Kursk Regional Clinical Hospital.
Grigoriev S.N., PhD, Head of the Unit of Purulent Surgery, Physician of the Unit of X-ray Surgical Methods of Diagnosis and Treatment 2 of BME Kursk Regional Clinical Hospital.
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