Case Study: What would you do? – Dr. Ravinder Singh
June Case of the Month Recap
A 33 year old Male obese but otherwise no systemic co-morbidities. Two year history of biliary colic and previous episode choledocholithiasis requiring ERCP. Got lost to follow-up over that 2 year period and didn’t get a cholecystectomy. Presented with cholangitis and required a repeat ERCP, sphincterotomy, and stent. Went on to have a sub-total cholecystectomy. No drain was left in-situ. Returns POD#5 with fevers, abdominal pain, and elevated WBC. He was admitted and put on IV ABX. CT image below. What would you do next?
1. IR Drainage
2. Surgical Drainage
3. Repeat ERCP and stent placement
4. Refer to HPB
Due to it being a weekend when he presented and he was getting septic, he was taken to the OR for a Laparoscopic Drainage of the biloma and peritoneal washout, and wide drainage. He went on to have a repeat ERCP and longer stent placed. He did well and was discharged home with outpatient follow-up with respect to the drain.
Conversation/results: download
Very interesting