Challenging Management of Acute Cholangitis in a Patient With Unextractable Common Bile Duct Stone Post Gastrojejunostomy Surgery

This case report details the management of an 89-year-old female with a complex surgical history, including cholecystectomy, left hepatectomy, and repair of an iatrogenic duodenal perforation, who presented with acute cholangitis due to a large common bile duct stone. Faced with the challenges of al...

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Bibliographic Details
Published inCurēus (Palo Alto, CA) Vol. 16; no. 2; p. e53561
Main Authors Lynn, Ryan M, Israel, Fady, Obanor, Steve O
Format Journal Article
LanguageEnglish
Published United States Cureus Inc 04.02.2024
Cureus
Subjects
Abdomen
Antibiotics
Bile ducts
Cholangitis
Cholecystectomy
Emergency medical care
Endoscopy
Gallstones
Gastroenterology
General Surgery
Hemodynamics
Hepatectomy
Iatrogenesis
Infections
Lithotripsy
Liver
Phosphatase
Preventive Medicine
Stents
Tomography
general surgery
gastrojejunostomy
electrohydraulic lithotripsy
acute cholangitis
acute cholelithiasis
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Summary:This case report details the management of an 89-year-old female with a complex surgical history, including cholecystectomy, left hepatectomy, and repair of an iatrogenic duodenal perforation, who presented with acute cholangitis due to a large common bile duct stone. Faced with the challenges of altered anatomy and the patient's frailty, a multidisciplinary team employed a series of interventions, including percutaneous transhepatic biliary drainage and endoscopic retrograde cholangiopancreatography (ERCP). The case was further complicated by difficulties in navigating the altered biliary tract, necessitating the use of advanced endoscopic techniques such as cholangioscopy and electrohydraulic lithotripsy (EHL) for stone fragmentation and removal, leading to the successful resolution of the obstruction. This report underscores the importance of individualized care and highlights the efficacy of innovative endoscopic approaches in managing complex biliary disorders in elderly patients with significant surgical histories.
ISSN:2168-8184
2168-8184
DOI:10.7759/cureus.53561