Abstract

Background: Obstructive jaundice is a common health problem with various complications including liver dysfunction as well as systemic complications. Proper treatment of the underlying etiology should be the primary goal in management. However, different therapeutic approaches have been tried in lowering the bilirubin serum levels when treatment of the underlying cause is not feasible or unsatisfactory. These approaches include extracorporeal liver support (e.g., Molecular Adsorbent Recirculating System (MARS), plasma exchange, and charcoal. To the best of our knowledge, this is the first case of marked hyperbilirubinemia that was successfully managed with combined ERCP and plasma ultrafiltration.
Case presentation: We describe a case of marked hyperbilirubinemia (73mg\dl) following cholelithiasis and acute suppurative cholangitis that was successfully treated by combined plasma ultrafiltration and internal drainage through ERCP and biliary stenting.
Conclusion: The collaborative teamwork between gastroenterologist, endoscopist and nephrologist thorough the combined biliary drainage with ERCP and ultrafiltration could save the life of a patient with marked hyperbilirubinemia.

Keywords: Hyperbilirubinemia; Plasmapheresis; Cholangitis; Mortality

Abbreviations: ERCP: Endoscopic Retrograde Cholangiopancreatography; MARS: Molecular Adsorpant Recirculating System; CBD: Common Bile Duct, IHBC: Intrahepatic Biliary Channel; MRCP: Magnetic Resonance Cholangiopancreatography