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World J Gastroenterol. Jun 28, 2010; 16(24): 3083-3086
Published online Jun 28, 2010. doi: 10.3748/wjg.v16.i24.3083
Published online Jun 28, 2010. doi: 10.3748/wjg.v16.i24.3083
Obstructing fungal cholangitis complicating metal biliary stent placement in pancreatic cancer
Brian Story, Michael Gluck, Department of Gastroenterology, Virginia Mason Medical Center, Seattle, WA 98101, United States
Author contributions: Story B and Gluck M contributed equally to this work; Gluck M performed the research; Story B and Gluck M designed the research and wrote the paper.
Supported by Virginia Mason Medical Center
Correspondence to: Brian Story, MD, Department of Gastroenterology, Virginia Mason Medical Center, Seattle, WA 98101, United States. brian.story@vmmc.org
Telephone: +1-206-5836079 Fax: +1-206-5832307
Received: January 15, 2010
Revised: February 7, 2010
Accepted: February 14, 2010
Published online: June 28, 2010
Revised: February 7, 2010
Accepted: February 14, 2010
Published online: June 28, 2010
Abstract
Biliary obstructions can lead to infections of the biliary system, particularly in patients with occluded biliary stents. Fungal organisms are frequently found in biliary aspirates of patients who have been on antibiotics and have stents; however, fungal masses, or “balls”, that fully obstruct the biliary system are uncommon and exceedingly difficult to eradicate. We present 4 cases of obstructing fungal cholangitis in patients who had metal biliary stents placed for pancreatic malignancies, and subsequently required aggressive antifungal administration along with endoscopic and radiologic interventions. This report also reviews approaches previously undertaken to manage severe obstructing fungal cholangitis.
Keywords: Obstructing fungal cholangitis; Biliary stents; Fungal balls; Pancreatic cancer; Biliary obstruction