RESUMEN
Background: Percutaneous transhepatic cholangiography [PTC] has been the preferred investigation to delineate the anatomy of biliary tract in patients with bile duct obstruction, whether iatrogenic obstruction or obstruction due to stone or malignant lesion. Then ERCP has been described to evaluate and to manage the obstructed common bile duct whether by papillotomy and stone retrival or by biliary stenting. Both PTC and ERCP are invasive technique and may be associated with serious complication as cholangitis and biliary injury, recently magnetic resonance cholangiography [MRC] has been described to evaluate the obstructed biliary tract and considered as a diagnostic tool superior to PTC and ERCP as its non invasive and non operator dependent technique
Methods: This was prospective study of 21 patients who had surgery for bile duct obstruction due to any cause [stone or malignant lesion or iatrogenic injury]. The patients divided into three equal groups. 7 patients underwent ERCP, 7 patients underwent PTC and 7 patients underwent MRC. The results of which were compared with the intra operative findings
Results: Both PTC, MRC and ERCP were comparable with regard to image quality, detection of intrahepatic bile duct dilatation, assessment of level of injury and detection of abnormalities such as intraduct calculi, cholangetic liver abscess and atrophy of liver lobe. MRC provided additional information including detection of associated fluid collection and portal hypertension in addition its non invasive non operator dependent technique. In three patients more than one puncture had to be performed during percutaneous trans- hepatic cholangiography to delineate the complete anatomy in addition its an invasive method to delineate and decompress the bile ducts. ERCP failed in two patients and MRC done to delineate the biliary tree but ERCP provided additional benefit about anatomy of bile ducts below level of obstruction and solve the problem completely by endoscopic papillotomy and stone retrieval or by stenting of common bile duct
Conclusion: MRC is an accurate and non invasive imaging procedure for preoperative evaluation of patients with a bile duct obstruction and is capable of providing additional information which may not be available with PTC and ERCP. But ERCP considered superior to MRC as a therapeutic procedure in spite of that PTC may be essential in some patient when ERCP failure has occurred to decompress the biliary tracts