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

Abstract

Only several cases of postprocedural choleresis (biliary hyperproduction) were reported, and guidance on management is scarce, although an application of octreotide was anecdotally described. We herein present a rare post-obstructive choleresis complicated with acute kidney injury due to dehydration, successfully treated with an off-label application of octreotide. A 58-year-old female, following cholecystectomy and choledochotomy with numerous stones extraction, developed excessive bile loss via a T-tube complicated with acute kidney injury. Despite aggressive fluid replacement, the patient continued to deteriorate, prompting a trial of subcutaneous octreotide 0.1 mg three times per day over five days. Therapy yielded a rapid decline in bile production with improved diuresis and normalizing kidney function. The patient was discharged with a ligated T-tube, which we removed a month later. The followup was unremarkable, with normalized laboratory findings and symptom-free. Early use of octreotide could help resolve complicated biliary hyperproduction; however, further research is required to determine the risks and benefits of such an approach.

The Contemporary Approach to Chylothorax— Single‐Center Experience with the Proposal of Management Algorithm

“…In most patients (13 patients, 92%), a conservative approach was initiated, including pleural drainage, nil per mouth regime, total parenteral nutrition, and octreotide 0.1 mg bid subcutaneously. Although treatment with octreotide, a somatostatin analog is of unproven value, its use was described in the successful treatment of several off-label indications, including chylothorax [11,12]. Surgical treatment was indicated relatively early in patients with thoracic drain production >800 mL per day beyond the fifth day of treatment and in a patient with blunt thoracic trauma.…”