Acute kidney injury due to high-output external biliary drainage in a patient with malignant obstructive jaundice: a case report

Abstract

Background Persistent high output is a rare but potentially serious complication of percutaneous biliary drainage. Case presentation A 68-year-old Sinhalese woman with a palliative self-expanding metal stent placed for an inoperable hilar cholangiocarcinoma presented with worsening obstructive jaundice. Ultrasonography showed intrahepatic duct dilatation with the self-expanding metal stent in situ . Since this was indicative of a blocked stent, percutaneous transhepatic cholangiogram-guided internal biliary stenting through the self-expanding metal stent was attempted and failed. Therefore, an external biliary drain was left in the dilated biliary system. Post procedure, she developed a high biliary output of 3–4 liters per day and went into oliguric acute kidney injury with metabolic acidosis, most probably due to inadequate fluid replacement and hypovolemia. Conclusion Although the mechanism by which this occurs in some cases is unclear, early identification and prompt fluid resuscitation prevent acute kidney injury. The adoption of new strategies for internal drainage of long complex strictures will both prevent and ameliorate this problem.

High Output External Biliary Drainage Leading to Acute Kidney Injury in a Patient with Malignant Obstructive Jaundice: A Rare Case Report

“…One of the earliest pieces of literature published byTaber et al in 1982 in the review of 120 cases showed 7 of the patients' daily biliary output exceeded average amount and only three exceeded outputs of more than 2 liters, as in our case demanding fluid resuscitation.2 In another case report published by Jayarajah et al mentioned development of high biliary output AKI in case of blocked SEMS and failure of internal catheterization requiring hemodialysis 6. Literature regarding percutaneous biliary procedure Nepal is limited, a study by Thapa A et al showed promising result in its role in palliation highlighting the need of further large scale study 4,7,8,9.…”

High-volume post-obstructive choleresis (biliary hyperproduction) with acute kidney injury after choledochotomy, gallstones extraction, and T-tube drainage, successfully treated with octreotide

“…6 The other two relevant studies are single case reports -both presented patients with dehydration and AKI due to high external biliary drainage, and one showed the beneficial effects of octreotide application. 2,7 The other 18 articles were excluded because they were not describing excessive bile secretion or octreotide use.…”

“…Theirpatient showed spontaneous resolution of choleresis with supportive measures, although the moment when the amount of bile secretion began to decrease is unclear. 7 Tiruneh et al described the favorable effect of octreotide on choleresis, and its use was reasonable based on its physiological potential to inhibit bile secretion mediated by secretin. 2 The patient presented with high output biliary loss (3-4 liters a day) after the percutaneous biliary drainage for malignant obstruction of the distal common bile duct.…”

Pathophysiological consequences and treatment strategy of obstructive jaundice

“…In 1990, a retrospective study revealed that 49% of patients with hepatoportal cholangiocarcinoma (HCCA)-associated OJ (130 cases) had developed acute renal failure[ 33 ]. The incidence of this complication ranges from 5% to 16%, and patient mortality rates were approximately 70%-80%[ 34 , 35 ].…”