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Complications of repeated percutaneous transhepatic biliary drainage (PTBD) for palliation of obstructive jaundice in cholangiocarcinoma patient

  • Radhitya Farizky Deta Juniawan ,
  • Ummi Maimunah ,
  • Titong Sugihartono ,
  • Ulfa Kholili ,
  • Budi Widodo ,
  • Husin Thamrin ,
  • Muhammad Miftahussurur ,
  • Amie Vidyani ,


Abstract

Background: Cholangiocarcinoma, a malignancy of the biliary duct system, has been recognized as the second most common cause of biliary tract and primary liver malignancies. The incidence has increased in the last three decades worldwide. Percutaneous transhepatic biliary drainage (PTBD) has been considered a highly important palliative therapy for bile duct obstruction due to its high success rate and low incidence of cholangitis. However, bleeding and catheter dislodgment are still found during the procedure. This case discusses the complications of repeated PTBD stent placement as palliative therapy in a patient with obstructive jaundice due to cholangiocarcinoma.

Case Presentation: A 58-year-old female presented with a chief complaint of weakness and pain on the right side of the abdomen, particularly at the site of PTBD stent installation three days before being admitted to Dr. Soetomo General Hospital. In 2017, the patient was diagnosed with cholangiocarcinoma­ with obstructive jaundice and had undergone PTBD procedure five times during the period of July 2017 to March 2018 due to biliary leakages. Laboratory investigation indicated elevated bilirubin, decreased potassium, increased random blood sugar, increased blood urea nitrogen, high levels of the 2-hour postprandial blood glucose, and elevated HbA1c, suggesting the conditions of cholangiocarcinoma with obstructive jaundice complicated with hypokalemia, acute kidney injury and type-2 diabetes. The blood smear also indicated normochromic normocytic anisopoikilocytosis anemia and leukocytosis. The patient improved after PTBD replacement, antibiotics treatment, packed red cells transfusion, and rehydration therapy.

Conclusion: This case highlights that the complication of PTBD could occur relatively frequently and to prevent the complications in patients with post-PTBD regular medical check-up is therefore recommended. In addition, it is also critical to improve the patient knowledge on how to prevent the bleeding and to avoid the conditions that are potentially increase the chance of catheter dislodgment.

Keywords: Palliative treatment percutaneous transhepatic biliary drainage obstructive jaundice cholangiocarcinoma

References

  1. Millar A. Management of Patients with Suspected Cholangiocarcinoma: Clinical Guidelines.editors: London Cancer Hepatic Pancreatic and Biliary (HPB) Faculty; 2014. 5,12,13.
  2. Madhusudhan KS, Gamanagatti S, Srivastava DN, Gupta AK. Radiological interventions in malignant biliary obstruction. World J Radiol. 2016;8(5):518–29. Available from: https://pubmed.ncbi.nlm.nih.gov/27247718
  3. Blechacz B. Cholangiocarcinoma: Current Knowledge and New Developments. Gut Liver. 2017;11(1):13–26. Available from: https://pubmed.ncbi.nlm.nih.gov/27928095
  4. Rizvi S, Gores GJ. Pathogenesis, diagnosis, and management of cholangiocarcinoma. Gastroenterology. 2013/10/15. 2013;145(6):1215–29. Available from: https://pubmed.ncbi.nlm.nih.gov/24140396
  5. Hameed A, Pang T, Chiou J, Pleass H, Lam V, Hollands M, et al. Percutaneous vs. endoscopic pre-operative biliary drainage in hilar cholangiocarcinoma - a systematic review and meta-analysis. HPB (Oxford). 2016/04/04. 2016;18(5):400–10. Available from: https://pubmed.ncbi.nlm.nih.gov/27154803
  6. Wiggers JK, Coelen RJS, Rauws EAJ, van Delden OM, van Eijck CHJ, de Jonge J, et al. Preoperative endoscopic versus percutaneous transhepatic biliary drainage in potentially resectable perihilar cholangiocarcinoma (DRAINAGE trial): design and rationale of a randomized controlled trial. BMC Gastroenterol. 2015;15:20. Available from: https://pubmed.ncbi.nlm.nih.gov/25887103
  7. Vanderveen KA, Hussain HK. Magnetic Resonance Imaging of cholangiocarcinoma. Cancer Imaging. 2004;4(2):104–15. Available from: https://pubmed.ncbi.nlm.nih.gov/18250017
  8. Khan SA, Davidson BR, Goldin RD, Heaton N, Karani J, Pereira SP, et al. Guidelines for the diagnosis and treatment of cholangiocarcinoma: an update. Gut. 2012;61(12):1657–69. Available from: http://dx.doi.org/10.1136/gutjnl-2011-301748
  9. Abbas M, Shamshad T, Ashraf M, Javaid R. Jaundice: a basic review. Int J Res Med Sci. 2016;1313–9. Available from: http://dx.doi.org/10.18203/2320-6012.ijrms20161196
  10. Valls C, Ruiz S, Martinez L, Leiva D. Radiological diagnosis and staging of hilar cholangiocarcinoma. World J Gastrointest Oncol. 2013;5(7):115–26. Available from: https://pubmed.ncbi.nlm.nih.gov/23919105
  11. Djalilah GN, Widayanti R, Setyoboedi B, Arief S. Magnetic resonance cholangiopancreatography as a diagnostic tools to diagnose biliary atresia at Dr.Soetomo hospital. Qanun Med - Med J Fac Med Muhammadiyah Surabaya. 2019;3(2):137. Available from: http://dx.doi.org/10.30651/jqm.v3i2.2131
  12. Vilgrain V. Staging cholangiocarcinoma by imaging studies. HPB (Oxford). 2008;10(2):106–9. Available from: https://pubmed.ncbi.nlm.nih.gov/18773065
  13. Pekey A, Zakaria R, Nainggolan L, Syam AF, Makmun D. Imaging Modalities Role inRecurrent Acute Pancreatitis Diagnosis. The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy. 2014;15(3):182-5.
  14. Kolev NY, Ignatov VL, Tonev AY. BILIARY DRAINAGE. J IMAB - Annu Proceeding (Scientific Pap. 2013;19(3):465–9. Available from: http://dx.doi.org/10.5272/jimab.2013193.465
  15. Dumonceau J-M, Tringali A, Papanikolaou I, Blero D, Mangiavillano B, Schmidt A, et al. Endoscopic biliary stenting: indications, choice of stents, and results: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline – Updated October 2017. Endoscopy. 2018;50(09):910–30. Available from: http://dx.doi.org/10.1055/a-0659-9864
  16. Amrita PNA, Bintoro SUY. Management strategy for an advanced head of pancreas carcinoma patient with obstructive jaundice. Drug Invention Today. 2019;13(6):893-5.
  17. Sabharwal T, Adam A. Biliary Tract Cancers: Extrahepatic Management. In: Katsanos K, Sabharwal T, Adam A, editors. Cardiovasc Intervent Radiol. 332010. p. 163-73.
  18. Venkatanarasimha N, Damodharan K, Gogna A, Leong S, Too CW, Patel A, et al. Diagnosis and Management of Complications from Percutaneous Biliary Tract Interventions. RadioGraphics. 2017;37(2):665–80. Available from: http://dx.doi.org/10.1148/rg.2017160159
  19. Björnsson E, Gustafsson J, Borkman J, Kilander A. Fate of patients with obstructive jaundice. J Hosp Med. 2008;3(2):117–23. Available from: http://dx.doi.org/10.1002/jhm.272
  20. Kholili U, Syalini DA. Surgery in Liver Diseases: Perioperative Evaluation & Management. Indones J Gastroenterol Hepatol Dig Endosc. 2016;17(1):49. Available from: http://dx.doi.org/10.24871/171201649-57
  21. Hadi U, Triyono EA. Medical Audit of the Management of Patients with Sepsis in the Intermediate Care Unit of Department Internal Medicine School of Medicine Airlangga University/Dr. Soetomo Hospital. Indones J Trop Infect Dis. 2016;1(1):1. Available from: http://dx.doi.org/10.20473/ijtid.v1i1.686
  22. Ranete M, Grasu M, Dumitru R, Rusu G, Toma M, G. Lupescu I. All About Percutaneous Biliary Drainage in Unresectable Cholangiocarcinoma. J Transl Med Res. 2017;22(2):84. Available from: http://dx.doi.org/10.21614/jtmr-22-2-119
  23. Tjempakasari A, Nasronudin N. Bacteria Caused Sepsis Biomarkers. Indones J Trop Infect Dis. 2015;5(3):67. Available from: http://dx.doi.org/10.20473/ijtid.v5i3.238
  24. Ahmad SS, Basheer FT, Idris SF, Hariraj R, Mathialagan R, Douds A. Cholangiocarcinoma presenting as hemobilia and recurrent iron-deficiency anemia: a case report. J Med Case Rep. 2010;4:133. Available from: https://pubmed.ncbi.nlm.nih.gov/20459809
  25. Abdel Rahim A, Elrefaiy MA, Morsy SA, El Saadany MM, Mashaal AR. Prevention of post-ERCP pancreatitis using pancreatic duct stenting in difficult cannulation patients with calcular biliary obstruction. Bali Med J. 2021;10(3):1061. Available from: http://dx.doi.org/10.15562/bmj.v10i3.2665

How to Cite

Juniawan, R. F. D., Maimunah, U. ., Sugihartono, T. ., Kholili, U. ., Widodo, B. ., Thamrin, H. ., Miftahussurur, M. ., & Vidyani, A. . (2022). Complications of repeated percutaneous transhepatic biliary drainage (PTBD) for palliation of obstructive jaundice in cholangiocarcinoma patient. Bali Medical Journal, 11(2), 850–855. https://doi.org/10.15562/bmj.v11i2.3465
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Radhitya Farizky Deta Juniawan
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Ummi Maimunah
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Titong Sugihartono
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Ulfa Kholili
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Budi Widodo
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Husin Thamrin
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Muhammad Miftahussurur
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Amie Vidyani
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