Diagnosis and treatment of "rapid decompression syndrome" in obstructive jaundice

Improving the results of treatment of patients with obstructive jaundice by reducing the incidence of "rapid decompression” syndrome. Material and methods. The results of complex diagnostics, diagnostics and treatment of 84 patients with "rapid decompression” syndrome with obstructive jaundice are analyzed. The "rapid decompression” syndrome most often developed in 36 (42.9%) cases after percutaneous-transhepatic cholangiostomy due to obstructive jaundice. In 34 (40.5%) cases after the formation of a traditional cholecystostomy (n = 17) and drainage of the common bile duct (n = 17). Only in 14 (16.6%) cases it developed after endoscopic papilosphincterotomy with nasobiliary drainage. To diagnose the "rapid decompression” syndrome, patients underwent dynamic ultrasound examination, studied the daily flow of bile according to the installed drains, as well as the rate of decompression of the bile ducts. To calculate the biliary rate, we used the formula proposed by T. Shimizu and modified by E.I. Galperin. Results. Depending on the methods of decompression of the bile ducts, the "rapid decompression” syndrome developed at different times of the post-decompression period. After percutaneous transhepatic cholangiostomy, the syndrome of "rapid decompression” developed on days 3-4 of the post-decompression period in 74% of patients, and in patients after traditional cholecystostomy and external drainage of the common bile duct on days 5-6 in 91% of patients.In the group of patients who underwent endoscopic decompression with nasobiliary drainage, the timing of the appearance of this syndrome was noted on days 7-8 in 94% of cases. It should be noted that the later this complication develops, the easier they are tolerated by patients. Conclusion. Thus, the treatment of patients with "rapid decompression” syndrome should be comprehensive and based on the data of the clinical manifestation of the disease, indicators of laboratory and ultrasound methods.