Fig. 1. Patient disconnected biliary system and permanent external biliary drain, multiple failed attempts to cross the occlusion. (A) Cholangiogram demonstrating a blind-ending, obstructed biliary system (arrow). (B) Cone-beam computed tomography showing Chiba needle (curved arrow) advanced through the anterior abdominal wall musculature and traversing the duodenum (‘D’) into the blind-ending biliary system (‘B’) with wire (arrow) already snared and pulled out through the percutaneous transhepatic biliary drainage tract. (C) Cholangiogram shows an internal/external biliary drain placed through the new bilio-enteric anastomosis.
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