Emergency ERCP for cholangitis in a 95-year-old patient

Cholangitis is an infection of the biliary tract with potentially high morbidity and mortality. It was described by Charcot in 1877 with the following triad of symptoms: fever, jaundice, and right upper quadrant pain. Many patients with severe cholangitis need an emergency biliary drainage. Choledocholithiasis and biliary tract manipulation are the most common causes of biliary obstruction resulting in cholangitis. This video presents the case of a 95-year-old woman who was admitted to the ICU for abdominal pain and fever.

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Emergency ERCP for cholangitis in a 95-year-old patient

Authors

Gf Donatelli, C Dabo, S Perretta, B Dallemagne, J Marescaux

Abstract

Cholangitis is an infection of the biliary tract with potentially high morbidity and mortality.
It was described by Charcot in 1877 with the following triad of symptoms: fever, jaundice, and right upper quadrant pain.
Many patients with severe cholangitis need an emergency biliary drainage.
Choledocholithiasis and biliary tract manipulation are the most common causes of biliary obstruction resulting in cholangitis. This video presents the case of a 95-year-old woman who was admitted to the ICU for abdominal pain and fever.

Keywords

Emergency ERCP, cholangitis, biliary obstruction, choledocholithiasis

Media type

Surgical video

Duration

04'00''

Publication

2011-03

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E-publication

WeBSurg.com, Mar 2011;11(03).
URL: http://www.websurg.com/doi-vd01en3229.htm

Emergency ERCP for cholangitis in a 95-year-old patient

2. Case presentation 00'19''

This video presents the case of a 95-year-old woman who was admitted to the ICU for abdominal pain and fever.

3. CT-scan 00'28''

The CT-scan demonstrated a 22mm dilated bile duct, containing two stones, a dilatation of the intrahepatic bile ducts and gallbladder lithiasis with a hydrocholecyst.

4. Papilla visualization 00'42''

An emergency endoscopic sphincterotomy has been decided upon after an antibiotic therapy was initiated. This protocol was undertaken 6 hours following the patient’s admission. The intervention was performed under general anesthesia with tracheal intubation. The patient was placed in a supine position. The protruding papilla was visualized in the second duodenum. Pus was coming out of it.

5. Catheterization 01'08''

The papilla was first catheterized. A guide wire was then placed in the common bile duct. The injection of contrast confirmed the dilatation of the intra- and extra-hepatic bile ducts with several radiolucent defects within the common bile duct.

6. Sphincterotomy 01'56''

An extensive sphincterotomy was performed, hence allowing to visualize the posterior wall of the common bile duct. Pus and a clear liquid originating from the hydrocholecyst were drained.

7. Stone retrieval 02'20''

The extractor balloon allowed to retrieve 4 stones less than 1cm large with sludge and pus. The balloon was inflated up to 15mm in diameter and passed without any resistance through the sphincterotomy. At the end of the examination, a radioscopic control evidenced aerobilia without any residual stone in the bile ducts. After the sphincterotomy, the patient’s outcome was rapidly favourable both clinically and biologically. Consequently, the patient was discharged only 3 days after her admission.