Endoscopic Management of Early and Potentially Life Threatening Complications of Plastic Biliary Stents: A Case Report

Introduction: The 5-year cumulative incidence of pyogenic liver abscess in a patient undergoing endoscopic sphincterotomy with biliary stenting is 2.4%. Diabetes appears to increase pyogenic liver abscess risk substantially, regardless of the presence or absence of other risk factors.

Case details: A 68-year-old lady with multiple comorbidities, past history of acute cholangitis with distal CBD stricture, and post-ERCP with CBD stenting presented with high fever with chills, pain abdomen, and loose watery stools. Blood investigations were suggestive of gram-negative sepsis, CECT abdomen showed liver abscess with CBD stent in situ. She was treated with antibiotics and two biliary stents for abscess drainage.

Discussion: Proximal migration of CBD plastic stent into right hepatic duct with poorly controlled diabetes has contributed to pyogenic liver abscess. Due to communication between the liver abscess cavity and biliary tree via stent, inaccessibility via percutaneous route, combined with high risk for surgical drainage; she was managed with plastic stent exchange and IV antibiotics.

Conclusion: Endoscopic biliary drainage is an effective treatment strategy for percutaneously inaccessible Liver abscess with biliary communication.

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Artikel online veröffentlicht:
22. April 2024