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Radiology route to rare jaundice relief

S.H. Irfan has got a fresh lease of life at 37. Forced to sell off his stationer’s store in Dhaka to treat his liver ailment, the eldest in a family of five siblings can now look forward to normalcy once he returns home. Irfan was the beneficiary of a radiological intervention at a city hospital when two metal stents were implanted to treat obstructive jaundice, “for the first time in eastern India”.

Irfan had landed up in Calcutta with a bilirubin count of 29 (normal is 1), after doctors in Dhaka said he would need major surgery to correct the critical condition. An ultrasound of the abdomen revealed obstructive jaundice, further confirmed by an MRCP (magnetic resonance colangio pancreatography). An ERCP (endoscopic retrograde colangio pancreatography) to confirm the site of block showed both ducts of the liver, which join to form the common bile duct, blocked by the tumour.

“The block was at the junction of the two ducts and we couldn’t open it by ERCP due to the tightness and multiplicity. So, we handed over the case to the radiology department,” said Mahesh K. Goenka, chief gastro-enterologist, Apollo Gleneagles Hospitals, who had first treated Irfan.

The alternative was the complicated surgery prescribed by the Dhaka doctors that involved resection of a part of the liver with anastomosis to connect the bile duct with the intestine. But, with the patient’s “dangerously high” bilirubin count, the risk in major open surgery was huge.

Usha Goenka, head of imaging and interventional radiology, Apollo Gleneagles, set out to treat the condition through a minimally-invasive radiological procedure, with the patient’s high bilirubin count in mind. “We made two holes in the liver through the skin and placed two external catheters, the tips of which were inside the left and right bile ducts, to help drain out the dirty bile,” she said.

The first stage of treatment brought down the bilirubin count to 19. The second stage involved manipulation of an ultra-thin wire through the narrowed (tumour) site into the common duct and intestine. “Then, after dilating it with a balloon, we placed two self-expanding metal stents across the tumour to create a Y-shaped artificial channel from the liver up to the intestine through the tumour,” said Usha Goenka.

This meant the bile could drain out into the intestine. After 24 hours, the external catheters were removed. The bilirubin count came down to 12 and the fever subsided. “I don’t feel any pain now and am looking forward to resuming a productive life back home,” said Irfan, before leaving for Dhaka.

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