Biliary dilatation

Biliary dilatation (also called dilation) is a procedure to stretch bile ducts that are too narrow. Bile, a substance that helps in the digestion of fats, is made in the liver and stored in the gallbladder. After meals it is excreted into the intestines via the bile ducts (also called biliary ducts). Sometimes the ducts become blocked or narrowed due to traumatic injury or surgery. If left untreated, this can lead to cholangitis (bile duct inflammation), liver abscess or secondary cirrhosis.

The Procedure

Using ultrasound and live X-ray (fluoroscopy) for guidance, a radiologist inserts a hollow needle through the skin, into the liver and into one of the bile ducts. A guide wire is threaded through the needle, into the duct, and the needle is removed. A tiny, deflated balloon is threaded along the wire, into the duct, and inflated to open up the narrow portion of the duct. Then a drainage catheter is placed into the duct to help the bile continue to drain; this catheter may stay in place for up to three months. The catheter will be connected to a drainage bag.

We will place a clear bandage and gauze over the catheter drain. The bandage must remain in place at all times; a nurse will instruct you on how to change it. In addition, the catheter will be secured with a locking device (StatLock®) which must not be removed.

During that time, your child will come to Interventional Radiology for X-rays to make sure the area is draining appropriately.

Anesthesia

Patients receive either IV sedation or general anesthesia and are asleep for this procedure.

Risks

The procedure is considered low-risk. However, potential complications include:

• bleeding
• infection
• injury to the gallbladder
• bile leak (biloma)
• bile duct perforation leading to biliary peritonitis (inflammation of the lining of the abdominal cavity)
• puncture of the lung (very rare)
• allergic reaction to X-ray dye (contrast reaction)

Pain

Some children feel pain or discomfort at the needle-insertion site, usually in the first day or two after the procedure. You may give over-the-counter pain medication.

Bathing

You may sponge bathe your child, but the bandage must be kept dry at all times.

Activity Restrictions

Your child will need to avoid activities that may result in a pull or other damage to the catheter.