Curbside Consultation in Endoscopy: 49 Clinical Questions, Second Edition

Joseph Leung, MD; Simon Lo, MD

Question 34: A 68-Year-Old Banker Who Had A Prior Whipple For Periampullary Cancer Had Recurrent Abdominal Pain And Fever For 3 Years. Each Resolved With Antibiotics. Lfts Are Impaired And Ct Scan Shows Dilated Intrahepatic Ducts And A Tubular Structure In The Pancreas. What Should I Do? (continued)

Jason B. Samarasena, MD; John G. Lee, MD

The differential diagnosis for a patient with abdominal pain after a Whipple procedure is broad and includes the conditions found in Table 34-1. The fact that this patient had fever and intrahepatic bile duct dilation associated with his abdominal pain narrows my focus toward cholangitis due to biliary obstruction. Biliary obstruction after a Whipple procedure is a relatively rare complication, with the more common causes being postoperative benign biliary strictures, choledocholithiasis, and malignant stricture from recurrent cancer. Given the fact that this patient has had recurrent…
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