EMERGENCY DRAINAGE PROCEDURES FOR GALL STONE DISEASE AND ITS COMPLICATIONS

GALL STONES WITH CBD STONE WITH SEVERE SEPSIS (ORGAN FAILURE-SEPTICAEMIA)

      This is a rare situation in which there will be a gall stone along with bile duct stone and severe systemic infection (Sepsis). This condition will be challenging for the treating doctor and also to the patient. Here the priority is to treat the systemic infection first to stabilize the patient and then to treat the actual disease.

      The common association of this situation is that the patient may have single or multiple organ failures. The suggestive clinical features are like decreased urine output with increased blood urea and serum creatinine in case of kidney failure (AKI), difficulty in breathing with poor oxygenation in lungs in case of respiratory failure (ARDS) or other system involvement.

      In this situation higher end antibiotics are used. Supporting the kidney with dialysis or supporting the lung with some type of assisted ventilation may be required.

      Coagulopathies are treated with blood product transfusion. The patient may not be ready for surgery at this point, but infection control is still necessary. This is achieved by some kind of radiological procedures.

      The commonly performed procedures are placing a stent in the bile duct to drain the infected bile by the procedure known as ERCP and stenting.  If the patient’s general condition is too poor then the alternative technique is percutaneous transhepatic biliary drainage (PTBD).