Abstract
BackgroundPersistent high output is a rare but potentially serious complication of percutaneous biliary drainage.Case presentationA 68-year-old Sinhalese woman with a palliative self-expanding metal stent placed for an inoperable hilar cholangiocarcinoma presented with worsening obstructive jaundice. Ultrasonography showed intrahepatic duct dilatation with the self-expanding metal stent in situ. Since this was indicative of a blocked stent, percutaneous transhepatic cholangiogram-guided internal biliary stenting through the self-expanding metal stent was attempted and failed. Therefore, an external biliary drain was left in the dilated biliary system. Post procedure, she developed a high biliary output of 3–4 liters per day and went into oliguric acute kidney injury with metabolic acidosis, most probably due to inadequate fluid replacement and hypovolemia.ConclusionAlthough the mechanism by which this occurs in some cases is unclear, early identification and prompt fluid resuscitation prevent acute kidney injury. The adoption of new strategies for internal drainage of long complex strictures will both prevent and ameliorate this problem.
Highlights
Persistent high output is a rare but potentially serious complication of percutaneous biliary drainage.Case presentation: A 68-year-old Sinhalese woman with a palliative self-expanding metal stent placed for an inoperable hilar cholangiocarcinoma presented with worsening obstructive jaundice
We report the case of a patient with high output from a biliary drain following percutaneous transhepatic cholangiogram (PTC)guided biliary drainage for malignant jaundice leading to hypovolemia and acute kidney injury (AKI)
We describe the occurrence of a high-output biliary drain following PTC-guided biliary drainage for malignant jaundice leading to hypovolemia and AKI
Summary
We described a case of persistent high output which is a rare but potentially serious complication of percutaneous biliary drainage. The mechanism by which this occurs in some cases is unclear, early identification and prompt fluid resuscitation prevents AKI. Aggressive fluid therapy, renal support with hemodialysis, octreotide, and NSAIDS were suggested to be effective in the management. The adoption of new strategies for internal drainage of long complex strictures will both prevent and ameliorate this problem
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