A CASE OF HYPER BILIRUBINEMIA AFTER CHOLEDOCHOTOMY

Abstract

We successfully saved a patient's life who developed severe hyperbilirubinemia after choledochotomy by treating according to hepatic failure and by closing an external fistula. A 53-year-old man was pointed out having gallstone when he was treated for hepatitis type C on an ambulant basis. HCV antibody was positive. On and after 4th hospital day, an increase in direct type dominant T-Bilirubin and increased and diluted exudate from a T-tube were observed. According to the treatment for postoperative hepatic failure. G.I. treatment was started, the T-tube was clamped, and eventually T-Bilirubin gradually decreased. We sometimes experience that a large quantity of diluted bile juice is exuded from an external fistula in cases of impaired liver function or cirrhosis, but we are not able to find courage to perform the internal fistulization at present. It is thought that internal fistulization of external biliary fistula with make bile acid increase, an increase in endotoxin inhibit, the hepatic blood flow increase, and the relief of obstructive jaundice stimulate. When a case of hyperbillirubinemia exuding a large quantity of diluted bile juice from an enternal fistula is encountered, we can expect to accelerate the relief of obstructive jaundice by clamping of the T-tube. This procedure appears to be worth to try before plasma exchange.