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Case report
Transcholecystic approach for distal common bile duct stricture in a non-dilated biliary system: an alternative route
  1. Syed Rahman1,
  2. Miltiadis Krokidis2 and
  3. Ioannis Paraskevopoulos1
  1. 1Clinical Radiology, Aberdeen Royal Infirmary, Aberdeen, UK
  2. 2Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
  1. Correspondence to Dr Syed Rahman; syedrahman2{at}


A 63-year-old patient was admitted to intensive treatment unit with biliary sepsis due to a small distal common bile duct stone. Endoscopic retrograde cholangiopancreatography was initially attempted for insertion of a biliary stent but failed due to the presence of a periampullary diverticulum. Referral to interventional radiology for percutaneous drainage was considered the next alternative even though there was no dilatation of intrahepatic ducts. Due to complete absence of intrahepatic duct dilatation, the traditional percutaneous transhepatic route was considered rather challenging. An alternative percutaneous approach via the gallbladder and subsequent catheterisation of the duodenum via the distal common bile duct was successfully performed instead without complication. We would like to describe this technique as an alternative option for drainage of the non-dilated biliary system in patients with sepsis.

  • Interventional radiology
  • Biliary intervention
  • Non-vascular

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  • Contributors SR: main author of the text; illustrator of the figures. MK: conceived the idea of taking a transcholecystic approach for this patient; lead operator of the patient discussed in the case report and captured images during operation; reviewed and edited the main body of the text and captions of all images; supervised this project. IP: second operator and identifier of the patient discussed in the case report and captured images during the operation; reviewed and edited the text of the case report.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.