Percutaneous transhepatic drainage is safe and effective in biliary obstruction—A single-center experience of 599 patients

Background Historically, surgical bilioenteric bypass was the only treatment option for extrahepatic bile duct obstruction, but with technological advancements, percutaneous transhepatic drainage (PTD) and endoscopic solutions were introduced as a less invasive alternative. Endoscopic methods may lead to a decreasing indication of PTD in the future, but today it is still the standard treatment method, especially in hilar obstructions. Methods In our retrospective data analysis, we assessed technical success rate, reintervention rate, morbidity, mortality, and the learning curve of patients treated with PTD over 12 years in a tertiary referral center. Results 599 patients were treated with 615 percutaneous interventions. 94.5% (566/599) technical success rate; 2.7% (16/599) reintervention rate were achieved. 111 minor and 22 major complications occurred including 1 case of death. In perihilar obstruction, cholangitis were significantly more frequent in cases where endoscopic retrograde cholangiopancreatography had also been performed prior to PTD compared to PTD alone, with 39 (18.2%) and 15 (10.5%) occurrences, respectively. Discussion The results and especially the excellent success rates demonstrate that PTD is safe and effective, and it is appropriate for first choice in the treatment algorithm of perihilar stenosis. Ultimately, we concluded that PTD should be performed in experienced centers to achieve low mortality, morbidity, and high success rates.

Endogenous Endophthalmitis and Liver Abscess: A Metastatic Infection or a Coincidence?

<i>Klebsiella pneumoniae</i> is a gram-negative pathogen that is a common cause of severe infections, including pyogenic liver abscess. Dissemination of <i>K. pneumoniae</i> to other organs, including the eye, is associated with significant morbidity and mortality. In the particular case of endogenous endophthalmitis (EE) by <i>K. pneumoniae</i> the prognosis is poor. We report the case of a middle-aged female with <i>K. pneumoniae</i> liver abscess. The patient developed metastatic endophthalmitis that was aggressively treated with systemic antibiotics. The liver abscess resolved with antimicrobials and percutaneous transhepatic drainage, but regarding the endophthalmitis she was discharged from our hospital without recovery of her eyesight. Metastatic spread to the eye should be considered in all patients with liver abscesses who experience ocular signs and symptoms in order to establish a timely diagnosis of EE.

Endogenous endophthalmitis associated with pyogenic liver abscess caused by Klebsiella pneumoniae: A case report

It is about an exceptional case of endogenous endophthalmitis secondary to a liver abscess due to Klebsiella pneumonia. The patient was a 50-year-old female, who was admitted for fever and right upper quadrant abdominal pain. Abdominal computed tomography showed an abscess measured 8 cm and located in segment 7 of the liver. It was treated by antibiotics and percutaneous transhepatic drainage. Pus sample was positive for Klebsiella pneumoniae. On day 3 after admission, patient complained of a red left eye with decreased vision. The diagnosis of endogenous endophthalmitis was strongly suspected. An Early treatment was initiated with a good evolution. The syndrome Endophthalmitis-hepatic abscess" is an exceptional syndrome rarely reported in the literature. It must evoked in case of hepatic abscess caused by klebsiella pneumonia.

Endogenous Endophthalmitis Associated with Pyogenic Liver Abscess Caused by Klebsiella Pneumoniae: A Case Report

It is about an exceptional case of endogenous endophthalmitis secondary to a liver abscess due to Klebsiella pneumonia. The patient was a 50-year-old female, who was admitted for fever and right upper quadrant abdominal pain. Abdominal computed tomography showed an abscess measured 8 cm and located in segment 7 of the liver. It was treated by antibiotics and percutaneous transhepatic drainage. Pus sample was positive for Klebsiella pneumoniae. On day 3 after admission, patient complained of a red left eye with decreased vision. The diagnosis of endogenous endophthalmitis was strongly suspected. An Early treatment was initiated with a good evolution. The syndrome Endophthalmitis-hepatic abscess is an exceptional syndrome rarely reported in the literature. It must evoked in case of hepatic abscess caused by klebsiella pneumonia.

Obstructive jaundice due to acute acalculous cholecystitis: ‘Mirizzi-like syndrome’

A 78 year-old female status post subarachnoid haemorrhage developed abdominal pain and obstructive jaundice. CT scan showed acute cholecystitis and dilation of the intrahepatic ducts. Endoscopic retrograde cholangiography revealed hepatic duct stenosis due to compression by an enlarged gallbladder. No stones were seen in the common hepatic duct and the cystic duct was patent. An endoscopic retrograde biliary drain was placed to relieve the obstructive jaundice due to acute acalculous cholecystitis. Percutaneous transhepatic drainage was performed to treat the acute acalculous cholecystitis. Hepatic duct stenosis was improved on endoscopic retrograde cholangiography performed 19 days after percutaneous transhepatic drainage. It may be reasonable to treat ‘Mirizzi-like syndrome’ non-operatively.

Percutaneous Transhepatic Intervention for Malignant Biliary Obstruction

Biliary obstruction is a serious clinical condition resulting from either benign or malignant etiologies. For malignant obstruction, curative resection is rarely performed due to disease progression, thus decompression drainage is the management of choice. Percutaneous transhepatic drainage and stenting are effective alternative treatments to surgical bypass and endoscopic biliary drainage when these two modalities are contraindicated. Percutaneous biliary intervention is safe and effective in both drainage and restoration of bile flow with high successful rate and acceptable risk of complication. Multidisciplinary approach, proper patient selection, careful image review and comprehensive knowledge of available techniques, success rates and complications are utmost importance for a successful procedure.

EUS-guided jejunoduodenostomy: another option for the management of stenosis in hepaticojejunoanastomosis

Our case report describes a patient with recurrent stenoses in both the right and left hepaticojejunoanastomoses due to an injury to the bile ducts during cholecystectomy several years ago. The anastomoses could not be reached endoscopically. EUS-guided hepaticogastrostomy would be a solution only for the left hepatic duct anastomosis. As the patient refused percutaneous transhepatic drainage (PTD) of both intrahepatic ducts and dilation of both anastomoses, endoscopic ultrasound-guided jejunoduodenostomy was performed using a lumen apposing metal stent (LAMS). This method provides repeated endoscopic access to the anastomoses of both hepatic ducts, allowing for their treatment.