|Discussion in 'All Categories' started by Niraj Girase - Jul 1st, 2012 7:59 am.|
|A patient suffered by hyperbilirubinemia & bilirubin level increased to 7.2 & it was found that the bile duct was blocked.Doctor advised gastroscopy & the stent was placed in right bile duct only because stenting in left bile duct was not possible due to very much narrowness.But again after 2 months the stent slipped but bilirubin level came to 1.8 before the stent slipped.Now once again stenting is done by gastroscopy but still patient suffers high fever.
What are causes of fever & what precaution taken?
re: Blockage of bile duct. by Dr J S Chowhan - Jul 1st, 2012 10:40 am
Dr J S Chowhan
|Dear Niraj Girase
You did not tell use what is the cause of blockage in your patient case as it could be due to stone or due to malignancy. The stent in CBD is introduced by ERCP and if there is fever after ERCP then there is chance of infection cholangitis or pancreatitis.
Endoscopic retrograde cholangiopancreatography (ERCP) is not as innocent procedure as it was thought once upon a time and definitely it is an invasive procedure that is performed to identify and treat pancreatic and biliary disease. In approximately 5%-10% of cases who go for ERCP, the procedure itself causes adverse events.
Diagnosis and management of ERCP-induced complications are carried out with clinical, laboratory, and radiologic procedures. Evaluation of the type and severity of the complication is essential and it is successfully performed with computed tomography (CT). The most common causes of post-ERCP pain are acute pancreatitis and duodenal perforation.
In severe pancreatitis, the pancreas is enlarged and enhances heterogeneously at CT. Pancreatic enhancement is diminished in regions of glandular necrosis. In duodenal perforation, CT may reveal extraluminal air or fluid. CT findings of acute duodenal hemorrhage are duodenal wall thickening and a high-attenuation mass in the duodenal wall. In infection, the bile ducts can be dilated and also the attenuation from the bile could be increased at CT. Abscesses appear as hypoattenuating masses with enhancing capsules.
CT findings of stent migration are an atypical location of the stent and bowel impaction. Other complications of ERCP are those associated with endoscopy and can include esophageal, liver, and splenic injury.
So ERCP should must be performed by a very skilled gastroenterologists.
J S Chowhan
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