title: A case of methicillin-resistant Staphylococcus aureus infection following bile duct stenting.
abstract: OBJECTIVE
  To present a case of methicillin-resistant Staphylococcus aureus (MRSA) infection following bile duct stenting in a patient with malignant biliary obstruction.
  
  
  METHODS
  A 78-year-old male patient was admitted to a community hospital with progredient painless jaundice lasting over two weeks, weight loss and sweating at night. Whether a stent should be implanted pre-operatively in jaundiced patients or whether these patients should directly undergo surgical resection, was discussed.
  
  
  RESULTS
  ERC and a biopsy from the papilla of Vater revealed an adenocarcinoma. In addition, a 7-Ch plastic stent was placed into the common bile duct. Persistent abdominal pain, increasing jaundice, weakness and indigestion led to the transfer of the patient to our hospital. A pylorus-preserving pancreatoduodenectomy was performed. Intraoperatively, bile leaked out of the transected choledochus and the stent was found to be dislocated in the duodenum. A smear of the bile revealed an infection with MRSA, leading to post-operative isolation of the patient.
  
  
  CONCLUSIONS
  As biliary stents can cause severe infection of the bile, the need for pre-operative placement of biliary stents should be carefully evaluated in each individual case.
authors.affiliation: Department of General Surgery, University of Heidelberg, Heidelberg, Germany.
authors.forename: Markus-K
authors.initials: MK
authors.lastname: Diener
authors.forename: Alexis
authors.initials: A
authors.lastname: Ulrich
authors.forename: Theresia
authors.initials: T
authors.lastname: Weber
authors.forename: Moritz N
authors.initials: MN
authors.lastname: Wente
authors.forename: Markus W
authors.initials: MW
authors.lastname: Büchler
authors.forename: Helmut
authors.initials: H
authors.lastname: Friess
mesh_terms: D000230:Adenocarcinoma / Q000150:complications; D000368:Aged; D001650:Bile Duct Neoplasms / Q000150:complications; D002779:Cholestasis / Q000209:etiology / Q000382:microbiology* / Q000601:surgery*; D004322:Drainage; D006801:Humans; D008297:Male; D016106:Methicillin Resistance; D011183:Postoperative Complications / Q000382:microbiology; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000188:drug therapy; D013211:Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification*; D015607:Stents