Endoscopic treatment of acute cholangitis as a late complication of papillectomy for adenoma of the papilla of Vater

Abstract

A 72-year-old man who had undergone endoscopic papillectomy for adenoma of the papilla of Vater 6 years earlier presented with general malaise and epigastric pain. Hematologic investigations revealed increased inflammatory markers and elevated hepatic enzymes, and abdominal computed tomography showed biliary dilatation. We diagnosed acute cholangitis. The patient was started on antibiotics on admission, but in the following 24 h developed fever, thrombocytopenia, systemic fibrinolysis, asthenia, sepsis, and disseminated intravascular coagulation syndrome. We performed endoscopic retrograde cholangiopancreatography, and confirmed stenosis of the inferior bile duct by cholangiography. The cholangitis improved after endoscopic biliary stenting. We subsequently performed endoscopic sphincterotomy for the bile duct and confirmed appropriate biliary outflow. Endoscopic treatment was effective for stenosis of the bile duct after endoscopic papillectomy.