Mucin-filled CBD, difficult to manage cholangitis

An elderly patient's pancreatobiliary puzzle: unraveling diagnosis and treatment challenges

Pancreatobiliary fistulas associated withntraductal Papillary Mucinous Neoplasm (IPMN) are rare and present therapeutic challenges. The authors describe the clinical course of an 81-year-old woman presenting with acute cholangitis, ultimately diagnosed with IPMN involving secondary ducts with focal high-grade dysplasia. Initial manifestations included elevated inflammatory markers, cholestasis, and imaging findings of a pancreatic lesion. Endoscopic retrograde cholangiopancreatography revealed dilation of both intrahepatic and extrahepatic bile ducts, along a cystic cluster originating from the pancreas, fistulizing into the common bile duct. Despite initial endoscopic interventions, recurrent cholestasis persisted. Subsequent multidisciplinary evaluation led to a cephalic duodenopancreatectomy. This case underscores the rarity of pancreatobiliary fistulas associated with IPMNs and the subsequent therapeutic challenges. The absence of standardized treatment algorithms for such intricate cases emphasizes the importance of individualized approaches. The fluoroscopy image displaying a cystic cluster originating from the pancreas and showing fistulization into the common bile duct is a rare image presented in our report, unique to this case.

Successful Management of Recurrent Cholangitis Post Cholecystectomy in a Primary Care Hospital

Cholangitis, a pathological disease characterized by inflammation of the biliary system, often occurs in conjunction with gallstone blockage and may lead to various problems, persisting for extended periods after cholecystectomy. The present report provides a comprehensive account of a clinical case involving a 35-year-old female patient who had undergone cholecystectomy three years before and is now experiencing symptoms consistent with cholangitis. The individual was originally given conservative therapy, which included the administration of intravenous ceftriaxone antibiotics, analgesics, fluids, and gastrointestinal treatment. Subsequently, they were sent to a tertiary care hospital for the performance of endoscopic retrograde cholangiopancreatography (ERCP) and the placement of a stent. Following a period of seven days, laboratory tests showed a return to normalcy, showing a positive outcome in response to the use of conservative management strategies. The patient made the decision to have an elective laparoscopic cholecystectomy, resulting in a favorable recuperation and a hospitalization period of 24 hours. The aforementioned results jointly demonstrate the efficacy of conservative therapy in treating cholangitis and the potential for eventual elective surgery in individuals experiencing prolonged gallbladder problems. In conclusion, this case underscores the need to maintain a state of alertness with respect to complications associated with cholecystectomy, such as cholangitis. It also emphasizes the effectiveness of conservative treatment approaches and the probable necessity for elective surgical intervention.