| Rendezvous Manoeuvre |
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Extensive
biliary duct carcinoma with jaandice and distant metastases.
The filiforme stenosis canīt be passed by
a guide wire during ERCP. Thus a percutaneous transhepatic
choledochal drainage (PTCD) is performed. The
cholangiogram (left) shows a sudden interruption of the
distal biliary duct by the tumor. Several days later the
transcutaneous catheter gets dislocated (right).
It is decided to perform a second PTC in order to attempt
stenting by means of a rendez vous manoeuvre.
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The guide wire is advanced
transcutaneously through
the stenosis and the papilla (left) to the duodenum.
A second examiner (Rendez vous) extracts the guide wire
orally using a snare (right). |
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Thereafter
a normal guide wire directed sphincterotomy and a ballon
dilatation is performed (left x-ray). Finally
a wall stent is implanted (right picture). The wall stent is
not yet expanded at the site of tumor stenosis. |
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The
stenosis is dilated carefully a second time, faciletating
sufficient bile flow thereafter. |
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The metall stent is in an
ideal location and protrudes
about 1 cm into the duodenal lumen. |
