Percutaneous transcystic duct metallic stenting is a useful therapeutic option for common bile duct obstruction: What surgeons should know

Background: Percutaneous transhepatic gallbladder drainage (PTGBD) is widely accepted when the obstruction is below the cystic bifurcation. However, unlike endoscopic retrograde biliary drainage (ERBD) or percutaneous transhepatic cholangial drainage (PTCD), PTGBD is not applicable for the further treatment of common bile duct (CBD) obstruction. Herein, we report a case in which the CBD obstruction was successfully treated with a metallic stent placed through the PTGBD route. Case: An 82-year-old man with jaundice was found with computed tomography to have a pancreatic head tumor and CBD obstruction. The ERBD had failed owing to severe CBD obstruction, and PTCD had failed owing to ultrasound visualization failure. To relieve the jaundice, temporal PTGBD was performed. One week later, a metallic stent was successfully placed in the CBD obstruction through the PTGBD route. The serum bilirubin level decreased from 18.3 to 0.9 mg/dl in 4 months, and this decrease helped improve the patient's quality of life. Conclusion: In selected cases, percutaneous transcystic duct biliary stenting can be a palliative treatment for CBD obstruction.