PubMed · 9700300
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T F Khan, M N Norazmi. 1998. Recurrent pyogenic cholangitis: is immune depression a feature?. https://doi.org/10.1177/004947559802800332
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A 62-year-old lady presented with fever and abdominal pain. History revealed cholecystectomy two years ago due to cholecystolithiasis, complicated by perforation of the common bile duct, leading to hepaticojejunostomy, jejunocholedochostomy, endoscopic retrograde insertion of two plastic stents and percutaneous drainage of bilioma. The patient was lost to follow-up until she presented two years later in the emergency room. ERC was performed. Both stents were occluded. After extraction dirty bile popped out. Injection of contrast medium showed stones in the remaining common bile duct and dilatation of the intrahepatic bile ducts and the interposed jejunum. After stone extraction a subphrenic intrahepatic fluid collection became visible when injecting contrast medium in the intrahepatic bile ducts. Pus was aspirated. The abscess was drained with a nasobiliary tube. Antibiotics were given. Temperature and CRP normalized. The nasobiliary tube was removed when the biliary fluid was clear. Recovery was uneventful with complete resolution of symptoms.
A diagnosis of liver metastasis, periportal adenopathy, or hepatobiliary cancer often is accompanied by findings of biliary obstruction. Malignant biliary obstruction frequently is associated with pruritus, anorexia, cholangitis, or hyperbilirubinemia, which that precludes treatment with chemotherapeutic agents that are excreted or metabolized hepatically. In patients with low biliary obstruction, endoscopic stent placement may accomplish drainage of the entire biliary tree without the need for an external device. Patients with high bile duct obstruction, on the other hand, may need a percutaneous approach to drain the target ducts and avoid draining an atrophic segment or lobe. This first of a series of two articles concerning palliative percutaneous biliary intervention will review the indications for biliary drainage and the preprocedure evaluation of this complicated patient population.