PMC4861884_01
CT demonstrates a dilated biliary tree with the colon preventing direct fluoroscopic drainage.
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The colon, however, was situated in such a way that a safe window for percutaneous access was not felt to exist (Fig. 1).
Two laparoscopic photographs demonstrate peritoneal implants (white arrow) and hepatic stick of the liver (black arrow).
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Exploration revealed multiple small nodules within the peritoneum, including nodules on the liver dome and within the omentum (Fig. 2). A second 21-gauge needle was used to access a more peripheral left bile duct (Fig. 2).
Fluoroscopic opacification of the biliary tree demonstrating a dilated system with a drain in good position.
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The Amplatz and safety wire were removed, and a repeat injection confirmed appropriate placement of the side holes; the catheter was then sutured into place (Fig. 3).