Endoscopic biliary drainage for choledocholithiasis in a patient with aplastic anemia before hematological engraftment after allogeneic transplantation.

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  • Additional Information
    • Source:
      Publisher: Japan Society Of Clinical Hematology Country of Publication: Japan NLM ID: 2984782R Publication Model: Print Cited Medium: Print ISSN: 0485-1439 (Print) Linking ISSN: 04851439 NLM ISO Abbreviation: Rinsho Ketsueki Subsets: MEDLINE
    • Publication Information:
      Publication: Tokyo : Japan Society Of Clinical Hematology
      Original Publication: Tokyo, Rinsho Ketsueki Kondankai.
    • Subject Terms:
      Bone Marrow Transplantation* ; Drainage* ; Endoscopy, Digestive System*; Anemia, Aplastic/*therapy ; Cholangitis/*therapy ; Choledocholithiasis/*surgery ; Common Bile Duct Diseases/*surgery ; Postoperative Complications/*therapy; Acute Disease ; Adult ; Anemia, Aplastic/complications ; Choledocholithiasis/complications ; Common Bile Duct Diseases/complications ; Fever/etiology ; Humans ; Male ; Neutropenia/etiology ; Perioperative Care ; Time Factors ; Transplantation, Homologous
    • Abstract:
      A 30-year-old man was diagnosed with severe aplastic anemia in 1997. He received mPSL pulse therapy and was treated with ATG and cyclosporine, resulting in remission and exacerbation; however, his pancytopenia gradually progressed and transfusions were required. He was referred to our hospital for further treatment by allogeneic bone marrow transplantation (allo-BMT). Before allo-BMT, he suffered febrile neutropenia. His white blood cell count was <100/microl despite daily administration of G-CSF. Although we detected asymptomatic stones in his gallbladder (GB) and common bile duct (CBD) by a screening test before allo-BMT, we decided to remove the stones after BMT because of his severe neutropenia. He underwent allo-BMT from an HLA-matched unrelated donor after conditioning with a reduced-intensity regimen. On day 9 after BMT, he developed acute obstructive suppurative cholangitis. Germ-free care was transiently stopped and endoscopic biliary drainage (EBD) was performed for the stones in the common bile duct. Engraftment of WBC was confirmed on day 24, and the stones were removed using endoscopic sphincterotomy on day 57 after confirmation of platelet recovery. We could perform EBD safely before hematological engraftment. A strategy for the management of asymptomatic stones of the GB and CBD has not yet been established. The possibility of removing stones before BMT should therefore be considered. Consideration should also be given to the possibility of improving acute obstructive suppurative cholangitis by EBD and antibiotics before hematological engraftment in such cases when stones cannot be removed before BMT.
    • Publication Date:
      Date Created: 20090602 Date Completed: 20091203 Latest Revision: 20090601
    • Publication Date:
      20240829
    • Accession Number:
      19483403