Late stent blockage by blood clot successfully treated by urokinase R. K. K. Lo, C. W. Lai, J. W.
K. K. Hsu, MD MBBS, MRCP MBBS, MRCP C. Leung, MD
Endoscopic stenting is an established treatment for the palliation of malignant biliary obstruction. 1. 2 Cholangitis or recurrent jaundice are common late complications resulting from stent clogging. Occlusion of 10 F stents occurs after 3 to 6 months. 3 The material blocking the stent consists of biliary sludge which includes bacteria,4. 5 unconjugated bilirubin, protein, and plant fibers. 6• 7 We report here a case of stent blockage due mainly to an organized blood clot causing cholangitis.
Figure 1. A long thread-like blood clot occluding the lumen of the stent.
CASE REPORT
A 54-year-old woman first presented with inoperable hilar cholangiocarinoma in March 1990. A 13-cm 10 F CottonLeung stent was inserted into the right hepatic duct for palliation of the obstructive jaundice. She was subsequently readmitted three times at 4-monthly intervals because of cholangitis requiring stent exchange. Examination of the lumen of the blocked stent revealed the presence of a bilestained sludge. In March 1991 she was readmitted again for cholangitis. Liver function tests showed a total bilirubin of 98/Lmol/liter (N
K. K. Hsu, MD MBBS, MRCP MBBS, MRCP C. Leung, MD
Endoscopic stenting is an established treatment for the palliation of malignant biliary obstruction. 1. 2 Cholangitis or recurrent jaundice are common late complications resulting from stent clogging. Occlusion of 10 F stents occurs after 3 to 6 months. 3 The material blocking the stent consists of biliary sludge which includes bacteria,4. 5 unconjugated bilirubin, protein, and plant fibers. 6• 7 We report here a case of stent blockage due mainly to an organized blood clot causing cholangitis.
Figure 1. A long thread-like blood clot occluding the lumen of the stent.
CASE REPORT
A 54-year-old woman first presented with inoperable hilar cholangiocarinoma in March 1990. A 13-cm 10 F CottonLeung stent was inserted into the right hepatic duct for palliation of the obstructive jaundice. She was subsequently readmitted three times at 4-monthly intervals because of cholangitis requiring stent exchange. Examination of the lumen of the blocked stent revealed the presence of a bilestained sludge. In March 1991 she was readmitted again for cholangitis. Liver function tests showed a total bilirubin of 98/Lmol/liter (N
