Emergency PTBD for cholangitic shock with severe thrombocytopenia from a retained CBD stent and distal CBD structure

Abstract

Background: Acute cholangitis complicated by septic shock carries high mortality and requires urgent biliary decompression. Percutaneous transhepatic biliary drainage (PTBD) remains a life-saving alternative when ERCP is not feasible. We report a 67-year-old patient who presented with severe cholangitic shock, multiorgan dysfunction, early acute respiratory distress syndrome (ARDS) and severe thrombocytopenia secondary to a retained and fractured common bile duct (CBD) stent. Due to failed previous ERCP attempts and distal CBD stricture, emergency PTBD was performed. Following biliary decompression and targeted antibiotic therapy for multidrug-resistant Klebsiella pneumoniae, the patient demonstrated significant clinical recovery. 5th day PTBD was internalised and 7 th day This case highlights the critical role of timely biliary decompression via PTBD in lifethreatening cholangitis when ERCP is not feasible.