Shruti Khurana, MD, Scott Larson, MD
University of Texas Health Science Center, Houston, TX
Introduction: Bile acid and salts depletion from percutaneous transhepatic cholangiodrainage (PTCD) in obstructive jaundice can lead to fat malabsorption causing malnutrition and fat-soluble vitamin deficiencies, dehydration, acute kidney injury (AKI) and electrolyte abnormalities. Bile reinfusion (BR) is a method of enteral feeding of biliary drain secretions for restoration of bile salts in the gut. We describe a case of oral BR in a patient with PTCD for choledocholithiasis.
Case Description/Methods: A 64 year-old Caucasian woman with history of gastric adenocarcinoma requiring subtotal gastrectomy and roux-en-y gastric reconstruction presented with nausea, vomiting, and epigastric pain. Imaging showed a stone in the mid common bile duct (CBD) measuring 0.7 x 0.6 cm causing mild biliary dilation. An endoscopic retrograde cholangiopancreatography (ERCP) was attempted with unsuccessful cannulation due to abnormal anatomy from prior surgeries. Hence, an open CBD exploration was performed for stone extraction and a 14 French percutaneous T-tube was placed for PTCD. Post-operatively, she developed large volume output (~1-2L/day) from the T-tube, loose stools and AKI with rise in creatinine from 1.12 to 2.96 mg/dL. She was started on BR 4 times/day by mouth (mixed with juice in 1:1 ratio). Over the next few weeks, she had resolution of diarrhea with a slow renal recovery.
Discussion: BR has shown variable success as reported in a few case reports and small studies mainly focusing on patients with pancreatitis with enteric fistulae, and obstructive cholangiocarcinoma [1,2]. Tripathy et. al. demonstrated that it is a cost-effective method for hastened renal recovery, a common complication in patients with obstructive jaundice . In conclusion, BR should be considered in patients with PTCD as an alternate to exogenous bile salt administration for improved enterohepatic equilibrium.
Citation: Shruti Khurana, MD, Scott Larson, MD. P1005 - BILE REINFUSION IN OBSTRUCTIVE JAUNDICE. Program No. P1005. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.