The patient presented with obstructive jaundice due to the compression of the common bile duct caused by liver cancer and enlarged retroperitoneal lymph nodes. The dilation of the bile duct was not evident, and the initial attempt at puncture under ultrasound guidance was unsuccessful, as the optimal puncture path was obstructed by the tumor. A sharp-angle puncture was performed, guided by CT, to access the left hepatic duct, and then further guided by DSA to navigate through the obstructed segment. Subsequently, internal and external biliary drainage catheter were successfully inserted.

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