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Case report
peer-reviewed

Successful Trial of Octreotide and Ketorolac for the Management of Increased Biliary Drain Output: A Case Report



Abstract

We describe a 69-year-old male patient with the status of obstructive jaundice post percutaneous biliary drainage for prior obstructive jaundice and who presented with a complaint of generalized weakness and increased output from the drainage tube. The patient developed worsening jaundice, which was noted to be obstructive in nature with a marked dilatation of the biliary tree and a distal obstruction of the common bile duct. Subsequently, a percutaneous biliary drain was placed for symptomatic management. However, the patient continued to have increased output from the drain, approximating 3-4 liters a day, which made the patient dependent on continuous intravenous hydration. The case presented a therapeutic challenge in reducing the drainage amount. We have tried a successful approach based on the physiologic effect of octreotide and nonsteroidal anti-inflammatory drugs (NSAIDs) in the formation of bile secretion. This approach has not been clearly described in the literature. We highlight the importance of further study to validate the use of these medications in similar clinical scenarios.



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Case report
peer-reviewed

Successful Trial of Octreotide and Ketorolac for the Management of Increased Biliary Drain Output: A Case Report


Author Information

Fasil Tiruneh Corresponding Author

Department of Internal Medicine, Howard University Hospital

Ahmad Awan

Department of Internal Medicine, Howard University Hospital

Abdullahi Musa

Department of Internal Medicine, Howard University Hospital

Daniel Chen

Internal Medicine, Washington Dc Va Medical Center


Ethics Statement and Conflict of Interest Disclosures

Human subjects: Consent was obtained by all participants in this study. Conflicts of interest: The authors have declared that no conflicts of interest exist.


Case report
peer-reviewed

Successful Trial of Octreotide and Ketorolac for the Management of Increased Biliary Drain Output: A Case Report


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Case report
peer-reviewed

Successful Trial of Octreotide and Ketorolac for the Management of Increased Biliary Drain Output: A Case Report

  • Author Information
    Fasil Tiruneh Corresponding Author

    Department of Internal Medicine, Howard University Hospital

    Ahmad Awan

    Department of Internal Medicine, Howard University Hospital

    Abdullahi Musa

    Department of Internal Medicine, Howard University Hospital

    Daniel Chen

    Internal Medicine, Washington Dc Va Medical Center


    Ethics Statement and Conflict of Interest Disclosures

    Human subjects: Consent was obtained by all participants in this study. Conflicts of interest: The authors have declared that no conflicts of interest exist.

    Acknowledgements


    Article Information

    Published: July 03, 2017

    DOI

    10.7759/cureus.1421

    Cite this article as:

    Tiruneh F, Awan A, Musa A, et al. (July 03, 2017) Successful Trial of Octreotide and Ketorolac for the Management of Increased Biliary Drain Output: A Case Report. Cureus 9(7): e1421. doi:10.7759/cureus.1421

    Publication history

    Received by Cureus: June 22, 2017
    Peer review began: June 23, 2017
    Peer review concluded: June 24, 2017
    Published: July 03, 2017

    Copyright

    © Copyright 2017
    Tiruneh et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

We describe a 69-year-old male patient with the status of obstructive jaundice post percutaneous biliary drainage for prior obstructive jaundice and who presented with a complaint of generalized weakness and increased output from the drainage tube. The patient developed worsening jaundice, which was noted to be obstructive in nature with a marked dilatation of the biliary tree and a distal obstruction of the common bile duct. Subsequently, a percutaneous biliary drain was placed for symptomatic management. However, the patient continued to have increased output from the drain, approximating 3-4 liters a day, which made the patient dependent on continuous intravenous hydration. The case presented a therapeutic challenge in reducing the drainage amount. We have tried a successful approach based on the physiologic effect of octreotide and nonsteroidal anti-inflammatory drugs (NSAIDs) in the formation of bile secretion. This approach has not been clearly described in the literature. We highlight the importance of further study to validate the use of these medications in similar clinical scenarios.



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Fasil Tiruneh, M.D.

Department of Internal Medicine, Howard University Hospital

For correspondence:
fasment2000@gmail.com

Ahmad Awan, M.D., Resident Physician

Department of Internal Medicine, Howard University Hospital

Abdullahi Musa

Department of Internal Medicine, Howard University Hospital

Daniel Chen

Internal Medicine, Washington Dc Va Medical Center

Fasil Tiruneh, M.D.

Department of Internal Medicine, Howard University Hospital

For correspondence:
fasment2000@gmail.com

Ahmad Awan, M.D., Resident Physician

Department of Internal Medicine, Howard University Hospital

Abdullahi Musa

Department of Internal Medicine, Howard University Hospital

Daniel Chen

Internal Medicine, Washington Dc Va Medical Center