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CHOLANGITIS LENTA FOLLOWING UPFRONT SPLEEN-PRESERVING TOTAL PANCREATECTOMY FOR IPMN-ASSOCIATED PANCREATIC CANCER
Mena Louis
2, Nicholas Minner
*1, Terence Jackson
2, Claudia Ormenisan-Gherasim
2, Nelson A. Royall
21Student, Edward Via College of Osteopathic Medicine - Carolinas Campus, Spartanburg, SC; 2Northeast Georgia Medical Center Gainesville, Gainesville, GA
Background: Cholangitis lenta (CL) is a rare and poorly reported cause of cholestatic liver failure in the post-procedural setting. CL has been almost exclusively reported in the liver transplant population, however has very limited identification in the non-transplant population.
Case Presentation: A 76 -year-old male underwent an upfront open spleen-preserving total pancreatectomy for IPMN-associated pancreatic ductal adenocarcinoma of the head without intra-operative complications. Post-operatively he developed progressive cholestatic liver failure with a persistent leukocytosis. Infectious workup demonstrated no viral, bacterial, or fungal infectious agent. Intra-operative biliary cultures demonstrated isolated findings of neutrophilic infiltration without identifiable infectious organisms. A thorough serologic and radiographic evaluation demonstrated no underlying etiology of cholestasis. A transjugular liver biopsy demonstrated characteristic findings of CL with dilated bile ductules along the portal tract periphery, diffuse inspissated bile within the ductules, and canalicular cholestasis. Despite empiric broad-spectrum antibiotic coverage and intensive hepatic supportive care, the liver failure progressed with eventual patient demise. with a history of IPMN presented with jaundice, weight loss, fatigue, and gastrointestinal symptoms. Imaging revealed multifocal pancreatic lesions and significant atrophy of the distal pancreas. After thorough evaluation, a total pancreatectomy was performed to achieve complete disease resection. Postoperatively, the patient developed unexpected complications, including cholangitis lenta—a rare condition characterized by intrahepatic cholestasis without biliary obstruction. Despite intensive medical care, he experienced acute kidney injury, coagulopathy, and eventually multi-organ failure, which led to his death.
Discussion: This case represents the first documented case of CL following pancreatobiliary procedures. CL is a rare diagnosis associated with suspected endotoxin or viral mediated cholestatic liver failure in the post-operative setting. To date, almost all cases reported have occurred in the liver transplant population. Due to the low utilization of liver biopsy in the evaluation of non-transplant liver failure, this likely represents a significantly underreported entity that warrants further study.
Conclusion: Cholestatic liver failure in the post-procedural and critical setting warrants routine liver biopsy in the absence of other confirmed causes of liver failure to identify CL.
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