Bedside Percutaneous Approach in a Critically Ill ICU Patient with Complex Pancreatobiliary Disorder Followed by Endoscopic Approach: Lessons Learnt from a Tertiary Referral Center

Abstract

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.

Exploring the Association Between Paralytic Ileus and Endoscopic Retrograde Cholangiopancreatography Complications Using the National Inpatient Sample Database

“…It can lead to high morbidity and mortality if not acutely cared for, diagnosed early, and managed appropriately [1,[4][5][6]. Pancreaticobiliary diseases can also cause patients to become severely ill and ERCP has been the mainstay for treatment [6][7][8][9][10]. By entering the biliary tree and using contrast dye, ERCP can better visualize obstructions, strictures, and structural anomalies that may be difficult to assess with other imaging modalities [5][6][7][8]11].…”

“…Pancreaticobiliary diseases can also cause patients to become severely ill and ERCP has been the mainstay for treatment [6][7][8][9][10]. By entering the biliary tree and using contrast dye, ERCP can better visualize obstructions, strictures, and structural anomalies that may be difficult to assess with other imaging modalities [5][6][7][8]11]. However, in 6-10% of patients, this technique can lead to complications such as infection, perforation, cholangitis, pancreatitis, and bleeding [10,12].…”