Percutaneous transhepatic cholangial drainage-guided methylene blue for fistulotomy using dual-knife for bile duct intubation: A case report

doi:10.4240/wjgs.v15.i6.1211

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Jun 27, 2023 (publication date) through Feb 16, 2026

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World Journal of Gastrointestinal Surgery

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Case Report

World J Gastrointest Surg. Jun 27, 2023; 15(6): 1211-1215
Published online Jun 27, 2023. doi: 10.4240/wjgs.v15.i6.1211

Percutaneous transhepatic cholangial drainage-guided methylene blue for fistulotomy using dual-knife for bile duct intubation: A case report

Bing-Xi Tang, Xin-Li Li, Ning Wei, Tao Tao

Bing-Xi Tang, Ning Wei, Tao Tao, Department of Gastroenterology, Zibo Central Hospital, Zibo 255000, Shandong Province, China

Xin-Li Li, Laboratory Section, Zibo Central Hospital, Zibo 255000, Shandong Province, China

Author contributions: Tang BX performed the endoscopic retrograde cholangiopancreatography procedure and wrote the manuscript; Tao T designed the research study; Li XL and Wei N helped collecting medical data; all authors have read and approve the final manuscript.

Informed consent statement: Informed written consent was obtained from the patients for the publication of this report and any accompanying images.

Conflict-of-interest statement: The authors declare that they have no conflict of interest.

CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).

Corresponding author: Tao Tao, PhD, Deputy Director, Department of Gastroenterology, Zibo Central Hospital, No. 54 Gongqingtuanxi Road, Zibo 255000, Shandong Province, China. tao_tao79@163.com

Received: January 25, 2023
Peer-review started: January 25, 2023
First decision: February 21, 2023
Revised: March 14, 2023
Accepted: April 17, 2023
Article in press: April 17, 2023
Published online: June 27, 2023
Processing time: 140 Days and 23.8 Hours

Abstract

BACKGROUND

Difficult bile duct intubation is a big challenge for endoscopists during endoscopic retrograde cholangiopancreatography (ERCP) procedure. We report a case of percutaneous transhepatic cholangial drainage (PTCD)-guided methylene blue for fistulotomy using dual-knife for bile duct intubation.

CASE SUMMARY

A 50-year-old male patient had developed obstructive jaundice, and ERCP procedure need to be performed to treat the obstructive jaundice. But intubation cannot be performed if the duodenal papilla cannot be identified because of previous surgery for a perforated descending duodenal diverticulum. We used PTCD-guided methylene blue to identify the intramural common bile duct before dual-knife fistulotomy, and bile duct intubation was successfully completed.

CONCLUSION

The method that combing methylene blue and dual-knife fistulotomy to achieve bile duct intubation during difficult ERCP is safe and effective.

Keywords: Percutaneous transhepatic cholangial drainage; Bile duct intubation; Endoscopic retrograde cholangiopancreatography; Methylene blue; Case report

Core Tip: We report a case of difficult bile duct intubation during endoscopic retrograde cholangiopancreatography (ERCP) procedure. We introduce the clinical features, findings of ERCP, and response to treatment in this male patient.