The complication rate for only percutaneous cholangiography is very low, with major complications being under 2%.  There are four major complications described, and medical practitioners should be aware of potential complications that may arise. 

1- Hemorrhage is the most concerning complication related to the technical difficulty of the procedure.[9] It can be subcapsular or intraperitoneal. Another form of bleeding is hemobilia resulting from the communication of the tract with a major vascular structure. The chance of severe hemobilia ranges from 0.2 to 4 percent.[10] Most hemorrhage is self-limited, but if the patient becomes unstable, another procedure may be necessary. The typical management of a hypotensive patient related to hemorrhage after a percutaneous cholangiogram would be embolization. Hepatic arteriography is useful to identify the source of bleeding, and transcatheter embolization can effectively stop the bleeding. If necessary, embolization should be selective to preserve as much functioning hepatic tissue as possible. 

2- Infection and bacteremia, which include cellulitis, cholangitis, and sepsis. To reduce infection risk, patients should receive the appropriate preprocedural antibiotics before the procedure begins.[3] Cholangitis is more common in ERCP than the percutaneous approach related to crossing the pancreatic ampulla, allowing enteric bacteria into the biliary system.  Cholangitis overall is more common in obstructive diseases related to malignant etiologies.[11][12] Cellulitis and cholangitis usually receive treatment with oral antibiotics. Sepsis may require hospitalization with culture and sensitivities for intravenous antibiotics.

3- Biliary leaks are another complication, subdivided into peritoneal or pleural biliary leaks.

4- Pneumothorax can occur with a right-sided approach.  Management includes sequential chest X-rays. If the patient remains stable, observation may be adequate; if not, a chest tube may be necessary.[3]

Other significant complications may arise when performing percutaneous biliary work but are usually related to the management of biliary pathology.