Prolonged cholestasis following successful removal of common bile duct stones: beware patients on estrogen therapy.
There are various well described forms of chronic cholestatic jaundice in adults, such as autoimmune cholangitis, drug-induced cholangitis and intrahepatic cholestasis of pregnancy. We present two cases of prolonged cholestasis following removal of gallstones at endoscopic retrograde cholangiopancreatography (ERCP) and subsequent clear cholangiography. Both patients were taking oral estrogens at the time of presentation, which were subsequently withdrawn. The first case responded rapidly to corticosteroid treatment, and the second case had a much slower resolution with ursodeoxycholic acid. Both cases highlighted the significance of estrogen-induced cholestasis in female patients with protracted jaundice following ERCP and removal of intra-ductal stones. After oral estrogens are discontinued, a short course of steroids needs to be considered.
Dunn
J M
JM
The Queen Elizabeth Hospital, Stadium Road, Woolwich, London, SE18 4QH, United Kingdom.
McNair
A
A
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D002756:Cholagogues and Choleretics / Q000627:therapeutic use; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002779:Cholestasis / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D015914:Estrogen Replacement Therapy / Q000009:adverse effects*; D004967:Estrogens / Q000009:adverse effects; D005260:Female; D042882:Gallstones / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D011183:Postoperative Complications / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D014580:Ursodeoxycholic Acid / Q000627:therapeutic use
D000305:Adrenal Cortex Hormones; D002756:Cholagogues and Choleretics; D004967:Estrogens; D014580:Ursodeoxycholic Acid