Bedside Percutaneous Approach in a Critically Ill ICU Patient with Complex Pancreatobiliary Disorder Followed by Endoscopic Approach: Lessons Learnt from a Tertiary Referral Center.
Autor: | Lesmana CRA; Hepatobiliary Division, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Medical Faculty University of Indonesia, Jakarta, Indonesia.; Digestive Disease and GI Oncology Center, Medistra Hospital, Jakarta, Indonesia., Herjuningtyas C; Department of Anesthesiology, Medistra Hospital, Jakarta, Indonesia., Inggriani S; Department of Radiology, Medistra Hospital, Jakarta, Indonesia., Pratiwi YE; Digestive Disease and GI Oncology Center, Medistra Hospital, Jakarta, Indonesia., Lesmana LA; Digestive Disease and GI Oncology Center, Medistra Hospital, Jakarta, Indonesia. |
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Jazyk: | angličtina |
Zdroj: | Case reports in gastroenterology [Case Rep Gastroenterol] 2021 Feb 18; Vol. 15 (1), pp. 210-217. Date of Electronic Publication: 2021 Feb 18 (Print Publication: 2021). |
DOI: | 10.1159/000513282 |
Abstrakt: | Pancreatobiliary disorder is a challenging clinical condition, especially when this condition is causing severe infection or biliary sepsis, and sometimes it requires intensive care unit (ICU) treatment. Biliary drainage is the mainstay of therapy; however, the choice of the drainage method is dependent on the patient's clinical condition and the disease itself. A 79-year-old female was transferred on a ventilator to our ICU from another hospital due to biliary sepsis, a large common bile duct stone, and an infected pancreatic pseudocyst. The patient also has other comorbidities such as heart problems, hypothyroidism, and diabetes mellitus. Bedside percutaneous transhepatic biliary drainage without fluoroscopy and percutaneous cyst aspiration was successfully performed, which improved the patient's condition; this was followed by an endoscopic approach, i.e., endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound-guided pancreatic pseudocyst drainage. The clinical improvement showed itself in the change of the patient's respiratory status and ventilator mode. In conclusion, the percutaneous approach has a big role in managing critically ill patients in the ICU setting. However, expertise, training experience, and a multidisciplinary team approach are very important for successful management and patient outcome. Competing Interests: The authors have no conflicts of interest. (Copyright © 2021 by S. Karger AG, Basel.) |
Databáze: | MEDLINE |
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