The experience of using indocyanine and low-frequency piezothromboelastography to assess liver failure in a patient with a tumor of the periampular zone complicated by obstructive jaundice

Pancreaticoduodenal resection is the only radical surgical method for the treatment of patients with malignant periampullary tumors. Mechanical jaundice in most cases is the first manifestation of the disease. Patients in this category are often emaciated, have impaired liver function and are at high risk of perioperative complications. One of the ways to solve this issue is preoperative drainage of biliary tract. At the same time, there are contradictory views on the optimal timing of radial surgery after biliary drainage. In this article we present our experience of using additional methods to assess liver function in a patient with mechanical jaundice, which allow us to optimize the treatment strategy. A 71-year-old patient diagnosed with adenocarcinoma of the large duodenal papilla complicated by intestinal bleeding and mechanical jaundice. Selective embolization of a. gastroduodenalis branches and percutaneous transhepatic biliary drainage were performed at the first stage. In the postoperative period active infusion and detoxification therapy was continued. On the 10th day the functional state of the liver and hemostasis system was evaluated using low-frequency piezothromboelatostography and evaluation of indocyanine green elimination: structural and chronometric hypocoagulation were eliminated, plasma elimination rate increased 5 times. On the 11th day the patient underwent pancreaticoduodenal resection, the postoperative period proceeded against the background of biochemical fistula formation. Thus, evaluation of indocyanine green elimination and low-frequency piezothromboelastography can be used in complex assessment of the patient’s condition when choosing the tactics of surgical treatment of patients with pancreaticoduodenal tumors complicated by mechanical jaundice.