Subcutaneous seeding of pancreatic carcinoma along a transhepatic biliary catheter tract

Biliary drainage catheters placed transhepatically are frequently used for decompression of the biliary system from obstructing masses. This technique has been found to be both safe and reliable with minimal complications. Recently Portner and Koolpe (1982) have described a technique of obtaining brush cytology from pancreatic or periampullary lesions via a specially designed double lumen catheter. The accuracy rate in obtaining malignant cells using this technique has been approximately 60%. It has been shown previously that techniques which are used for obtaining malignant cells for diagnosis place the patient at risk for the dissemination of tumour. For example, cases have previously been documented of malignant seeding along tracts following skinny needle aspiration biopsy performed transabdominally for carcinoma of the pancreas (Ferrucci et al, 1979; Smith et al, 1980). Three cases of malignant seeding along the biliary drainage catheter placed transhepatically have been previously documented (Kim et al, 1982; Oleaga et al, 1980). We describe below a fourth case of a metastatic lesion along the tract of a biliary drainage catheter placed for obstructive jaundice secondary to carcinoma of the pancreas. A 51-year-old white woman was admitted to another university hospital in December, 1981 with a two-month history of abdominal pain, generalised malaise and jaundice. Evaluation, including CT scan of the abdomen, revealed obstructive jaundice, probably secondary to a pancreatic tumour. There was no evidence of liver metastasis on CT scan. The total bilirubin at the time of admission was 26.7 mg/dl.