Figure 40.

Image of a percutaneous transhepatic biliary drainage (PTBD) (blue arrows) partially included on the CXR (a) previously shown also in the Figure 4b (mispositioned left jugular CVC). The patient suffered a duodenum rupture after a car accident, so the PTBD was placed to drain the bile from the choledocum into the distal part of the duodenum, therefore bypassing the point of rupture, as shown in the abdominal X-ray (b); a Pezzer catheter (red arrows) was also placed in the duodenal lumen through the breach to further drain eventual other secretions. Multiple other drainage tubes as well as metallic screws and plate are present.