Modified Retroperitoneal Access for Percutaneous Intervention after Pancreaticoduodenectomy
A 57 year-old man, who had pancreaticoduodenectomy 3 years prior to the distal common bile duct cancer, was found with a small hypodense 1.5 cm enhancing mass in the surgical bed on surveillance CT (). Due to overlying vascular structures and bowel loops, direct anterior approach was not possible. Using the similar technique, with the patient in the left lateral decubitus position, under a CT fluoroscopy, the 16 G guide needle of a QC biopsy set (Cook Medical, Bloomington, IN, USA) was inserted into the space between the segment VI of the liver and the right kidney (). Hydrodissection was performed in a similar fashion, while advancing the guide needle, which created a safe passage. On reaching the region of interest, the biopsy needle was inserted in a co-axial fashion, obtaining 4 cores of tissue. By applying the external torque to the guide needle, the biopsy chamber could be deflected into different areas of the mass to increase a sampling yield. The patient was discharged after 4 hours of observation, and histology revealed a recurrent cholangiocarcinoma.