Review article

https://doi.org/10.57140/mj.53.1.5

High-volume post-obstructive choleresis (biliary hyperproduction) with acute kidney injury after choledochotomy, gallstones extraction, and T-tube drainage, successfully treated with octreotide - Report of a case

Luka Blagus orcid.org/0000-0002-4102-1268 ; General hospital Zadar, department of surgery, Zadar, Croatia
Jakov Mihanović orcid.org/0000-0001-6450-2956 ; General hospital Zadar, department of surgery, Zadar, Croatia; University of Zadar, Department of health studies, Zadar, Croatia
Emilio Dijan orcid.org/0000-0003-2052-1690 ; General hospital Zadar, Department of surgery, Zadar, Croatia
Petra Grbić Pavlović ; General hospital Zadar, Department of nephrology, Zadar, Croatia
Iva Pavić ; General hospital Zadar, Department of radiology, Zadar, Croatia
Ivo Ćoza orcid.org/0000-0002-4358-657X ; General hospital Zadar, Department of surgery, Zadar, Croatia
Ivan Bačić orcid.org/0009-0006-1581-1844 ; General hospital Zadar, Department of surgery, Zadar, Croatia; University of Zadar, Department of health studies, Zadar, Croatia

Abstract

Only several cases of postprocedural choleresis (biliary hyperproduction) were reported, and guidance
on management is scarce, although an application of octreotide was anecdotally described.
We herein present a rare post-obstructive choleresis complicated with acute kidney injury due to
dehydration, successfully treated with an off-label application of octreotide. A 58-year-old female,
following cholecystectomy and choledochotomy with numerous stones extraction, developed excessive bile
loss via a T-tube complicated with acute kidney injury. Despite aggressive fluid replacement, the patient
continued to deteriorate, prompting a trial of subcutaneous octreotide 0.1 mg three times per day over five
days. Therapy yielded a rapid decline in bile production with improved diuresis and normalizing kidney
function. The patient was discharged with a ligated T-tube, which we removed a month later. The followup was unremarkable, with normalized laboratory findings and symptom-free.
Early use of octreotide could help resolve complicated biliary hyperproduction; however, further
research is required to determine the risks and benefits of such an approach.

Keywords

biliary excretion; choledocholithiasis; acute kidney injury; octreotide; off-label use

Hrčak ID:

303188

URI

https://hrcak.srce.hr/303188

Publication date:

1.6.2023.

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