Complications of Biliary Stenting in Pancreatic Cancer Patients

Biliary stent complications?

Hello Dr.
Yang, my mother was recently diagnosed with stage II pancreatic cancer.
To manage her jaundice, she underwent endoscopic biliary stenting.
After the procedure, she was living normally, but starting on the sixth day, she experienced recurrent chills and fever, along with severe abdominal pain.
Initially, we thought it was the onset of cancer pain (she had no significant pain before the stenting), and within six days, she visited the emergency room four times for morphine pain relief.
Shortly after the last morphine administration, she fell into a state of unconsciousness, with a bilirubin level of 13, and was diagnosed with sepsis.
She was immediately transferred from a regional hospital to a teaching hospital (the same hospital where the stent was placed).
After three days of antibiotic treatment, her bilirubin levels did not decrease, and she was confirmed to have cholangitis.
A person who was previously able to move normally became so weak that she could not open her eyes or think clearly after having two tubes inserted.
I would like to ask Dr.
Yang, the physician has repeatedly emphasized that my mother's bilirubin levels were already this high! However, that is not the case! If this failure is considered a normal complication, should he not also acknowledge the error of the surgical failure to the family? Can we request compensation for the subsequent medical expenses arising from this complication? For example, the out-of-pocket cost for albumin over three days is $4000...
Now we have to wait until this jaundice is under control before proceeding with chemotherapy, which may delay treatment by 2 to 3 months! This is very detrimental for rapidly progressing pancreatic cancer...
(Thank you in advance for your response.)

Xiao Hong Dou, 30~39 year old female. Ask Date: 2017/05/03

Dr. Yang Zhichao reply Gastroenterology and Hepatology

Dear Little Red Bean, pancreatic cancer is known for its unpredictable progression.
While placing a metal stent may resolve most jaundice issues, there are still situations where jaundice may not improve.
The use of self-paid albumin should not be related to the metal stent; it should be administered based on the patient's condition as needed.
It is unclear how compensation would be associated with this.
I recommend first assessing the current function of the metal stent to determine if it is displaced or obstructed by a tumor.
Since I have not reviewed any patient images, I cannot provide you with specific advice.
Please communicate further with the responsible physician for more information.
Changhua Hospital cares about your health.

Reply Date: 2017/05/03

More Info

Biliary stenting is a common procedure performed in patients with pancreatic cancer, particularly when there is a need to relieve obstructive jaundice caused by tumor growth. While this intervention can provide significant symptomatic relief and improve the quality of life, it is not without complications. In your mother's case, the development of fever, chills, severe abdominal pain, and subsequent diagnosis of cholangitis and sepsis following stenting raises important considerations regarding the risks associated with this procedure.

Complications of Biliary Stenting
1. Cholangitis: This is an infection of the bile duct system that can occur if the bile flow is obstructed or if there is contamination during the stenting procedure. Symptoms typically include fever, chills, jaundice, and abdominal pain. In your mother's case, the onset of these symptoms six days post-procedure suggests a possible infection related to the stent placement.

2. Sepsis: This is a life-threatening condition that arises when the body's response to infection causes injury to its own tissues and organs. The development of sepsis following cholangitis is a serious complication that requires immediate medical intervention, often involving hospitalization and aggressive antibiotic therapy.

3. Stent Migration or Occlusion: Biliary stents can migrate from their original position or become occluded due to sludge or tumor growth. This can lead to recurrent jaundice and the need for additional interventions.

4. Pancreatitis: In some cases, the placement of a biliary stent can irritate the pancreas, leading to pancreatitis, which can further complicate the clinical picture.

5. Hemorrhage: Although rare, bleeding can occur during or after the stenting procedure, particularly if there is underlying vascular involvement.

Medical Responsibility and Compensation
Regarding the medical responsibility and potential for compensation, it is essential to understand that while complications can arise from medical procedures, not all complications are indicative of negligence or a failure of care. The key factors to consider include:
- Informed Consent: Patients should be informed of the potential risks and complications associated with any procedure. If your mother was adequately informed about the risks of biliary stenting, it may be challenging to argue that the physician is at fault for the complications that arose.

- Standard of Care: If the complications that occurred were within the realm of expected outcomes for this procedure, it may not constitute a failure of care. However, if there was a deviation from the standard of care that directly led to the complications, there may be grounds for a medical malpractice claim.

- Documentation and Communication: It is crucial to have clear documentation of your mother's condition before and after the procedure, as well as communication with the healthcare team regarding her symptoms and treatment decisions.

Next Steps
1. Consult with the Healthcare Team: It is important to have open communication with the medical team involved in your mother's care. Discuss her current condition, the complications she has faced, and the rationale behind the treatment decisions made.

2. Seek a Second Opinion: If there are concerns about the management of her complications or the appropriateness of the care provided, consider seeking a second opinion from another specialist.

3. Legal Consultation: If you believe there has been negligence or a failure to meet the standard of care, consulting with a medical malpractice attorney may provide clarity on your options regarding compensation for medical expenses incurred due to complications.

4. Focus on Recovery: While navigating these complex issues, it is also essential to focus on your mother's recovery and the management of her pancreatic cancer. Delays in chemotherapy can impact her prognosis, so addressing her current health status and stabilizing her condition should be a priority.

In conclusion, while biliary stenting can be a lifesaving procedure, it carries risks that can lead to significant complications. Understanding these risks, the context of your mother's care, and the potential for medical responsibility is crucial as you navigate this challenging situation.

Similar Q&A

Post-Surgery Complications After Bile Duct Cancer Treatment

Dear Doctor, I would like to consult you regarding my father. Three years ago, he underwent surgery for early-stage bile duct cancer, during which his gallbladder, pancreas, and part of his stomach were removed. Recently, he has been experiencing rectal bleeding. He went to the ...

Dr. Lin Minghui reply Gastroenterology and Hepatology
Hello, regarding gastrointestinal bleeding, a small bowel endoscopy revealed a bleeding point that could not be controlled, along with issues related to stroke, indicating a more complex condition. Generally, the treatment for gastrointestinal bleeding aims to stabilize vital sig...

Understanding Ampullary Tumors: Treatment Options for Elderly Patients

Hello, currently my grandfather is hospitalized at the Xinfeng Madou Branch. According to the physician, the tumor is located at the ampulla of Vater, near the junction of the bile duct, pancreas, and duodenum, but it has not invaded the pancreas. There is an abscess that has bee...

Dr. Yang Zhichao reply Gastroenterology and Hepatology
Dear Mr./Ms. Guozi, The treatment you mentioned is indeed the standard surgical approach for treating ampullary tumors. The drainage you referred to is likely external drainage. Our hospital offers a non-surgical treatment option, which involves placing a metallic biliary stent ...

Understanding Duodenal Ampulla Cancer: Insights from Treatment Reports

Hello, In May of this year, my mother was diagnosed with stage IV duodenal ampullary cancer and is not a candidate for surgery. After six cycles of chemotherapy, the tumor did not shrink, and she underwent three additional cycles. She just completed her ninth chemotherapy sessi...

Dr. Chen Sirong reply Oncology
Buee / 42 years old / Male 1. How is the progression of the disease? A: The assessment of the condition is best left to his attending physician. 2. Attached are the CEA and CA19-9 data, which seem to have suddenly surged twice recently. Does this indicate that the chemotherapy...

Post-Cholecystectomy: Understanding Long-Term Effects and Dietary Concerns

Recently, I underwent a cholecystectomy and common bile duct resection with jejunal anastomosis due to a cyst in the common bile duct complicated by stones (the doctor mentioned that a segment of the small intestine was used to replace the bile duct). I would like to ask the doct...

Dr. Chen Zhiping reply Gastroenterology and Hepatology
Reply: Hello, 1. Due to the resection of the common bile duct, the hepatic duct is directly connected to the intestine. This results in the loss of the protective function and sphincter control of the original bile duct, theoretically increasing the risk of intestinal contents ...