70 year old female with obstructive jaundice

Discussion started by David Pier, at 20th May 2013 - 15:49pm

70 yr old female presents with obstructive jaundice. 7 kg weight loss. No other significant comorbidity.

Bilirubin 300 umol/l (N<21umol/l), INR=2.8 (N<1.2)

Day 1: CT: see image. No distant disease

Day 3: ERCP: failed to cannulate CBD

Day 4: Post ERCP pancreatitis. Predicted mild. CRP at 48 hrs 35mg/l.

How to proceed?

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New comment by Saxon Connor, at 7th Jun 2013 - 18:46pm

Day 11: Readmitted for Whipple.

Findings: severe necrotising pancreatitis with widespread involvement of retroperitoneum

How to proceed?