Gastrointestinal interventions

Case 1: Bilateral percutaneous biliary drainage for obstructive jaundice due to cholangiocarcinoma. Ken U. Ekechukwu, MD, MPH, FACP.

History: An 87-year-old man was admitted to a hospital because of jaundice. He was found to have conjugated and unconjugated hyperbilirubinemia, the former more than the latter. His cross-sectional imaging revealed marked dilation of his extra-hepatic and intra-hepatic bile ducts that proved inaccessible at endoscopic retrograde cholangiopancreatography (ERCP). He was referred to interventional radiology for […]

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Case 2: Percutaneous decompression of the biliary system. Ken U. Ekechukwu, MD, MPH, FACP.

Normal drainage of bile may be impaired by cancer, benign strictures, or gallstones that obstruct the biliary pathways and  cause bile to accumulate above the obstruction. This dilates the ducts above the obstruction and forces bile to “leak” into the blood stream, turning the eyes, skin, and urine yellow – biliary jaundice. Biliary malignancy can […]

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Case 3: Percutaneous gastrostomy. Ken U. Ekechukwu, MD, MPH, FACP.

Sometimes feeding a patient by mouth is impossible or contraindicated, and providing them adequate nutrition becomes a challenge. Substituting oral nutrition with parenteral (intravenous) nutrition is fine when temporary, but not when prolonged; it has its own challenges and complications. In such a situation, a patient can receive a gastrostomy or gastrojejunostomy feeding tube. Providing […]

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