Obstructive jaundice due to a blood clot after ERCP: a case report and review of the literature
Abstract Background Endoscopic retrograde cholangiopancreatography (ERCP) is one of the most frequently performed procedures for the treatment of biliary-pancreatic diseases. The most frequent complications of ERCP include pancreatitis, haemorrhage, perforation and cholangitis. While post-ERCP bilia...
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| Format: | Article |
| Language: | English |
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BMC
2018-11-01
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| Series: | BMC Gastroenterology |
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| Online Access: | http://link.springer.com/article/10.1186/s12876-018-0898-4 |
| _version_ | 1819079692212240384 |
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| author | Yangbei Zhu Shuling Wang Shengbing Zhao Lin Qi Zhaoshen Li Yu Bai |
| author_facet | Yangbei Zhu Shuling Wang Shengbing Zhao Lin Qi Zhaoshen Li Yu Bai |
| author_sort | Yangbei Zhu |
| collection | DOAJ |
| description | Abstract Background Endoscopic retrograde cholangiopancreatography (ERCP) is one of the most frequently performed procedures for the treatment of biliary-pancreatic diseases. The most frequent complications of ERCP include pancreatitis, haemorrhage, perforation and cholangitis. While post-ERCP biliary bleeding leading to biliary obstruction is rare. Case presentation We herein report a case of exceptional post-ERCP cholangitis due to a blood clot in the common bile duct (CBD). This case involves a 75-year-old woman with a history of recurring upper abdominal pain. Abdominal computerized tomography (CT) revealed dilatation of the extrahepatic bile duct with stones at the lower CBD. After ERCP, clearance of stones was obtained. The post-ERCP course was symptomatic with upper abdominal pain and a significant increase in cholestatic parameters. A second CT scan demonstrated a markedly dilated biliary tree with a longitudinal high-density image at the middle CBD. The patient was successfully treated with a repeated ERCP, and a blood clot was extracted. We also present a review of the literature published between 1985 and 2016 in PubMed. Four similar cases were reported during this period from France, Turkey, the USA and the UK, separately. Our case is the first reported in China. Conclusions Post-ERCP biliary bleeding leading to biliary obstruction is rare. We describe a rare case of post-ERCP cholangitis due to a blood clot in the common bile duct (CBD), which is consistent with most clinical presentations of similar cases already described. An analysis of the possible pathophysiological mechanisms and a review of the current literature are provided. We attempt to attract clinicians’ attention to the differential diagnosis of post-ERCP obstruction. The complications might be severe or even fatal. The diagnosis of blood clot is based on clinical and laboratory data, particularly imaging. Repeated ERCP is often necessary and effective. |
| first_indexed | 2024-12-21T19:33:01Z |
| format | Article |
| id | doaj.art-30d1c1cdbca44701b3a8a342a6048149 |
| institution | Directory Open Access Journal |
| issn | 1471-230X |
| language | English |
| last_indexed | 2024-12-21T19:33:01Z |
| publishDate | 2018-11-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Gastroenterology |
| spelling | doaj.art-30d1c1cdbca44701b3a8a342a60481492022-12-21T18:52:39ZengBMCBMC Gastroenterology1471-230X2018-11-011811510.1186/s12876-018-0898-4Obstructive jaundice due to a blood clot after ERCP: a case report and review of the literatureYangbei Zhu0Shuling Wang1Shengbing Zhao2Lin Qi3Zhaoshen Li4Yu Bai5Department of Gastroenterology, Changhai Hospital, Second Military Medical UniversityDepartment of Gastroenterology, Changhai Hospital, Second Military Medical UniversityDepartment of Gastroenterology, Changhai Hospital, Second Military Medical UniversityCompany Six, Student Brigade, Second Military Medical UniversityDepartment of Gastroenterology, Changhai Hospital, Second Military Medical UniversityDepartment of Gastroenterology, Changhai Hospital, Second Military Medical UniversityAbstract Background Endoscopic retrograde cholangiopancreatography (ERCP) is one of the most frequently performed procedures for the treatment of biliary-pancreatic diseases. The most frequent complications of ERCP include pancreatitis, haemorrhage, perforation and cholangitis. While post-ERCP biliary bleeding leading to biliary obstruction is rare. Case presentation We herein report a case of exceptional post-ERCP cholangitis due to a blood clot in the common bile duct (CBD). This case involves a 75-year-old woman with a history of recurring upper abdominal pain. Abdominal computerized tomography (CT) revealed dilatation of the extrahepatic bile duct with stones at the lower CBD. After ERCP, clearance of stones was obtained. The post-ERCP course was symptomatic with upper abdominal pain and a significant increase in cholestatic parameters. A second CT scan demonstrated a markedly dilated biliary tree with a longitudinal high-density image at the middle CBD. The patient was successfully treated with a repeated ERCP, and a blood clot was extracted. We also present a review of the literature published between 1985 and 2016 in PubMed. Four similar cases were reported during this period from France, Turkey, the USA and the UK, separately. Our case is the first reported in China. Conclusions Post-ERCP biliary bleeding leading to biliary obstruction is rare. We describe a rare case of post-ERCP cholangitis due to a blood clot in the common bile duct (CBD), which is consistent with most clinical presentations of similar cases already described. An analysis of the possible pathophysiological mechanisms and a review of the current literature are provided. We attempt to attract clinicians’ attention to the differential diagnosis of post-ERCP obstruction. The complications might be severe or even fatal. The diagnosis of blood clot is based on clinical and laboratory data, particularly imaging. Repeated ERCP is often necessary and effective.http://link.springer.com/article/10.1186/s12876-018-0898-4Endoscopic retrograde cholangiopancreatography (ERCP)Common bile duct (CBD)Endoscopic sphincterotomy (EST)Blood clot |
| spellingShingle | Yangbei Zhu Shuling Wang Shengbing Zhao Lin Qi Zhaoshen Li Yu Bai Obstructive jaundice due to a blood clot after ERCP: a case report and review of the literature BMC Gastroenterology Endoscopic retrograde cholangiopancreatography (ERCP) Common bile duct (CBD) Endoscopic sphincterotomy (EST) Blood clot |
| title | Obstructive jaundice due to a blood clot after ERCP: a case report and review of the literature |
| title_full | Obstructive jaundice due to a blood clot after ERCP: a case report and review of the literature |
| title_fullStr | Obstructive jaundice due to a blood clot after ERCP: a case report and review of the literature |
| title_full_unstemmed | Obstructive jaundice due to a blood clot after ERCP: a case report and review of the literature |
| title_short | Obstructive jaundice due to a blood clot after ERCP: a case report and review of the literature |
| title_sort | obstructive jaundice due to a blood clot after ercp a case report and review of the literature |
| topic | Endoscopic retrograde cholangiopancreatography (ERCP) Common bile duct (CBD) Endoscopic sphincterotomy (EST) Blood clot |
| url | http://link.springer.com/article/10.1186/s12876-018-0898-4 |
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