Endoscopic biliary drainage for choledocholithiasis in a patient with aplastic anemia before hematological engraftment after allogeneic transplantation

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  • OKADA Kohei
    Department of Gastroenterology and Hematology, Hokkaido University Graduate School of Medicine
  • HASHINO Satoshi
    Department of Gastroenterology and Hematology, Hokkaido University Graduate School of Medicine
  • TAKAHATA Mutsumi
    Department of Gastroenterology and Hematology, Hokkaido University Graduate School of Medicine
  • ONOZAWA Masahiro
    Department of Gastroenterology and Hematology, Hokkaido University Graduate School of Medicine
  • KAHATA Kaoru
    Department of Gastroenterology and Hematology, Hokkaido University Graduate School of Medicine
  • KONDO Takeshi
    Department of Gastroenterology and Hematology, Hokkaido University Graduate School of Medicine
  • IMAMURA Masahiro
    Department of Hematology and Oncology, Hokkaido University Graduate School of Medicine
  • ASAKA Masahiro
    Department of Gastroenterology and Hematology, Hokkaido University Graduate School of Medicine

Bibliographic Information

Other Title
  • 同種骨髄移植後生着前の総胆管結石症に対し，内視鏡的胆道ドレナージを施行した再生不良性貧血
  • 症例報告 同種骨髄移植後生着前の総胆管結石症に対し,内視鏡的胆道ドレナージを施行した再生不良性貧血
  • ショウレイ ホウコク ドウシュ コツズイ イショク ゴ セイチャク マエ ノ ソウタンカン ケッセキショウ ニ タイシ ナイシキョウテキタンドウ ドレナージ オ シコウ シタ サイセイ フリョウセイ ヒンケツ

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Abstract

A 30-year-old man was diagnosed with severe aplastic anemia in 1997. He received mPSL pulse therapy and was treated with ATG and cyclosporine, resulting in remission and exacerbation; however, his pancytopenia gradually progressed and transfusions were required. He was referred to our hospital for further treatment by allogeneic bone marrow transplantation (allo-BMT). Before allo-BMT, he suffered febrile neutropenia. His white blood cell count was <100/μl despite daily administration of G-CSF. Although we detected asymptomatic stones in his gallbladder (GB) and common bile duct (CBD) by a screening test before allo-BMT, we decided to remove the stones after BMT because of his severe neutropenia. He underwent allo-BMT from an HLA-matched unrelated donor after conditioning with a reduced-intensity regimen. On day 9 after BMT, he developed acute obstructive suppurative cholangitis. Germ-free care was transiently stopped and endoscopic biliary drainage (EBD) was performed for the stones in the common bile duct. Engraftment of WBC was confirmed on day 24, and the stones were removed using endoscopic sphincterotomy on day 57 after confirmation of platelet recovery. We could perform EBD safely before hematological engraftment. A strategy for the management of asymptomatic stones of the GB and CBD has not yet been established. The possibility of removing stones before BMT should therefore be considered. Consideration should also be given to the possibility of improving acute obstructive suppurative cholangitis by EBD and antibiotics before hematological engraftment in such cases when stones cannot be removed before BMT.

Journal

  • Rinsho Ketsueki

    Rinsho Ketsueki 50 (5), 419-423, 2009

    The Japanese Society of Hematology

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