Peripheral portal vein-oriented non-dilated bile duct puncture for percutaneous transhepatic biliary drainage

Figure 1 A 57-year-old man who had undergone living donor liver transplantation with right posterior sectional graft 8 mo earlier presented with recurrent cholangitis due to stricture of the bilioenteric anastomosis. A: Computed tomography shows that the intrahepatic bile duct (BD) is not dilated. The arrow indicates a peripheral branch of B6; B: Under ultrasonographic guidance, a non-dilated peripheral branch of B6 is punctured along its running course with a 21-G needle; C: While controlling the needle tip, a 0.018-inch guide-wire (GW) is inserted carefully into the BD; D: When the hydrophilic 0.035-inch GW crosses the anastomotic stricture, a 7-Fr catheter with distal curve crosses the stenotic bilioenteric anastomosis and advances into the jejunal loop.