title: [Insertion of percutaneous transhepatic biliary endoprosthesis for unresectable lower cholangiocellular carcinoma following cholangitis due to endoscopic biliary plastic stent obstruction].
abstract: The patient was an 87-year-old woman who was diagnosed with atrial fibrillation, which was treated with an anticoagulant, and with chronic kidney disease. The patient was diagnosed as having liver dysfunction and lower cholangiocellular carcinoma (cStage I) on ultrasonography and magnetic resonance cholangiopancreatography. Since it was impossible to perform curative resection owing to the patient's decreased cardiac and renal function, we performed palliative endoscopic retrograde biliary drainage (ERBD) with a plastic stent (PS), and the patient was discharged 11 days later. However, the patient was readmitted because of fever (>38.0°C) and vomiting 124 days after ERBD. We assumed that the patient had developed cholangitis due to PS obstruction. Moreover, her blood culture was positive for Klebsiella pneumoniae. We were unable to replace the PS as the tumor had increased in size and hemorrhage from the papilla of Vater continued after the stent had been removed. The signs of inflammation improved after treatment of sepsis with antibiotics and immunoglobulins, and we performed percutaneous transhepatic cholangio drainage( PTCD) and eventually inserted a percutaneous transhepatic biliary endoprosthesis (PTBE) with an expandable metallic stent (EMS). The patient died 2 months later; no stent occlusion was observed. Our experience suggests that endoscopic biliary stents should be selected bearing in mind the patency of the stent and the prognosis.
authors.affiliation: Dept. of Gastroenterology, Tokyo Metropolitan Health Medical Treatment Corporation Toshima Hospital.
authors.forename: Mayumi
authors.initials: M
authors.lastname: Kondo
authors.forename: Eiko
authors.initials: E
authors.lastname: Okamoto
authors.forename: Kentaro
authors.initials: K
authors.lastname: Takagi
authors.forename: Atsushi
authors.initials: A
authors.lastname: Tamura
authors.forename: Takao
authors.initials: T
authors.lastname: Shibayama
authors.forename: Ryota
authors.initials: R
authors.lastname: Seki
authors.forename: Jun
authors.initials: J
authors.lastname: Takasaki
authors.forename: Hidetoshi
authors.initials: H
authors.lastname: Amagasa
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Kamikozuru
authors.forename: Hideaki
authors.initials: H
authors.lastname: Ganno
authors.forename: Katsunori
authors.initials: K
authors.lastname: Ami
authors.forename: Akira
authors.initials: A
authors.lastname: Fukuda
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nagahama
authors.forename: Masayuki
authors.initials: M
authors.lastname: Ando
authors.forename: Kuniyoshi
authors.initials: K
authors.lastname: Arai
mesh_terms: D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000473:pathology / Q000628:therapy*; D001653:Bile Ducts, Intrahepatic; D018281:Cholangiocarcinoma / Q000628:therapy*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002761:Cholangitis / Q000209:etiology*; D004322:Drainage; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D009367:Neoplasm Staging; D019736:Prostheses and Implants; D015607:Stents / Q000009:adverse effects