Editing Percutaneous transhepatic cholangiography (section)

== Complications ==

* Haemobilia/haemorrhage
** 2-8%
** Usually a result of injury to a major vessel (hepatic artery or vein or PV)
** RUQ pain, bleeding from I/E drain, melena/haematochezia, etc
* Sepsis
* Biloma
* Peritonitis
* Pancreatitis
* Pleural effusions
* Death
* Leakage of bile around catheter
** Often due to catheter occlusion - may need to be exchanged
** Differentiate from ascites leaking - may be able to treat this with purse-string suture around catheter
* Excessive bile losses
** Occurs with complete distal obstruction
** Complications
*** Fluid and electrolyte depletion (see 'liver anatomy' for relevant electrolytes in bile). Can check concentration of solutes in bile vs urine to establish whether biliary losses are responsible.
*** Metabolic acidosis
*** Malabsorption
*** Diarrhoea
*** ADKI
** Management
*** Careful replacement of electrolytes/fluid
*** Octreotide to reduce bile production?
*** Exogenous bile salts
*** Recirculation (more cost-effective and reno-protective than giving exogenous bile salts)
** Indications for recirculation
*** Losses >1.5L/day (as per YO)
*** Refractory hyponatraemia or other fluid/electrolyte problems
** Contraindications
*** Suspected infection in bile (based on observation of colour, or other factors including isolation of resistant organisms on culture and high bacterial counts on microscopy)
** Recirculation route
*** Orally - not palatable, nausea-inducing - can mix with fizzy drinks
*** Naso-enteral tube
** Benefits
*** Reduction in serum bilirubin
*** Possibly improved host defences 
*** Improved gut function
*** The overall level of evidence is low, with no prospective RCTs