Percutaneous ultrasound-guided puncture of the gallbladder (PUPG)

Percutaneous ultrasound-guided puncture of the gallbladder (PUPG) is a new method for antegrade study of the gallbladder and the common bile duct. All procedures were scheduled immediately prior to planned surgery. Under ultrasound guidance, a 22-gauge sheathed needle was placed into the gallbladder lumen, and dilute (25% to 30%) diatrizoate meglumine (Hypaque) was injected. Indications in five patients included: evaluation of the common bile duct for calculi and/or obstruction, specifically in one patient who had hypersensitivity to intravenous contrast material; aspiration of bile for gram stain, crystal analysis, and cytology; evaluation of the gallbladder lumen for intraluminal masses; and to establish the anatomic site of an occult abscess. A small bile leak occurred in one patient who had no obstruction, and a more significant leak occurred in a patient who had obstructive jaundice and ampullary carcinoma. PUPG obviated the need for surgical intervention in three patients. Although the method has limited indications, we feel that it has great diagnostic potential in conditions related to the gallbladder and biliary ducts.