Seeding of gallbladder carcinoma along the tract after percutaneous transhepatic choledochoscopy

An implant metastasis developed along the tract after percutaneous transhepatic cholecystoscopy 5 months after initial placement of the catheter into the gallbladder. Percutaneous transhepatic cholecystoscopy is conducted by insertion of choledochofiberscope into the gallbladder through the dilated sinus tract established around a catheter inserted into the gallbladder. The catheter had been placed for total of 15 days. Two days after the removal of the catheter, cholecystectomy supplemented by partial resection of the liver was carried out because of the extent of a gallbladder carcinoma. The choledochofiberscope used was Olympus CHF type 4B, with a thinner flexible part 5.0 mm in diameter. It is not surprising that carcinoma of the biliary tract or pancreas may seed along the tract of a biliary drainage catheter, but only few reports describing such incidence related to percutaneous transhepatic biliary drainage have previously been published. Physicians should be aware of this complication whenever a firm nodule develops at the site of previous entry of a biliary drainage catheter in a patient with malignant obstruction.