Internalization of a second transhepatic biliary access with a captured microwire forced-buckle maneuver:...

Percutaneous biliary drains are classified into external and internal/external drains. Internal/external drains can drain bile externally and internally (ie, anatomically) into bowel. Internal drainage is usually desired because it is associated with less morbidity. Not infrequently, operators encounter a situation in which one of two transhepatic biliary access tracts has been successfully internalized, and a second access cannot be internalized. The present report describes a technique that internalizes a second percutaneous transhepatic biliary access-relying on an initially successful first internalization-by capturing a microwire from the externalized to the internalized tract and forcing it down into the bowel. The anatomic applications and results of this technique are described.