A True "Lifeline"! How Doctors Turned the Tide for a Nonagenarian

Race Against Time: Reversing a Life Crisis in 30 Minutes

At the beginning of the new year in 2025, Huang Lang was urgently admitted to HeYou Hospital due to the sudden onset of persistent chills, high fever, vomiting, and weakness in both lower limbs, with his condition rapidly deteriorating. The team led by Dr. Xie Zhiquan, Director of the Department of Geriatric Medicine, diagnosed acute suppurative cholangitis (caused by bile duct stone obstruction) based on comprehensive examinations including blood tests and abdominal imaging. “The patient is showing signs of pre-septic shock and is in immediate danger. To halt disease progression and save his life, the stone must be removed to relieve the obstruction within 24 hours!” Dr. Xie Zhiquan decisively initiated a multidisciplinary consultation.

Facing the complex situation of a nonagenarian with multi-organ dysfunction, Dr. Li Zijun, Director of the Department of Gastroenterology, who participated in the consultation, proposed an innovative approach: using Endoscopic Retrograde Cholangiopancreatography to establish a minimally invasive life channel. “Traditional open surgery is highly traumatic, and given the patient’s advanced age, his vital organs could hardly withstand a major operation. ERCP only requires inserting an endoscope through the mouth to remove the stone and drain the bile, but it poses a significant challenge to the physician’s skill, team coordination, and effective treatment,” explained Dr. Li.

Dr. Li Zijun’s team performing the procedure | Archival Image

With full support from the Department of Anesthesiology throughout the procedure, Dr. Li Zijun’s team urgently performed endoscopic retrograde cholangiopancreatography. The endoscope was inserted orally, passed through the esophagus and stomach, and advanced to the descending part of the duodenum. The papilla was successfully located and cannulated for cholangiography. Subsequently, a sphincterotome was inserted over a guidewire to incise the duodenal papilla. A stone retrieval balloon was then used to successfully extract an oval-shaped stone and a large amount of purulent fluid from the common bile duct. The stone measured approximately 7x8 mm. Finally, a 5 mm nasobiliary drainage tube was placed into the common bile duct for continuous bile drainage. The entire procedure took about 30 minutes.

After the procedure, the patient’s vital signs gradually stabilized. Twelve hours later, he resumed a liquid diet and was successfully discharged three days later. The family members, holding the medical staff’s hands with tears of gratitude, said: “This is a successful example of the collaborative efforts of the Gastroenterology, Geriatric Medicine, and Anesthesiology departments. It is the best New Year’s gift the medical team could have given him, granting him a ‘second chance at life’!”

Dr. Li Zijun (right) during rounds

Warmth Continues: Gratitude from Another Recovered Patient

On the same day as Huang Lang’s surgery, the Departments of Geriatric Medicine and Gastroenterology received another special New Year’s gift—a thank-you call from patient Liu Yi (pseudonym): “Thank you, Dr. Xie, for your sharp diagnosis in identifying the cause, and thank you, Dr. Li, for using a thin tube to spare me from the pain of surgery!” She had suffered severe pain from a common bile duct stone half a month prior and has now fully recovered after ERCP stone removal. The treatment stories of these two patients are like a “Tale of Two Lives” written together by doctors and patients.

This battle against disease, transcending age, is not only a typical case of critical care for the elderly in the region but also a testament to the physician’s “millimeter-level” minimally invasive technique and unwavering spirit.

Science Focus: Why is Acute Suppurative Cholangitis Fatal?

Acute suppurative cholangitis is a biliary tract infectious disease characterized by sudden onset, rapid progression, and critical severity. It is primarily caused by obstruction of the biliary system due to various factors (such as bile duct stones, biliary ascariasis, etc.), which prevents normal bile drainage, leading to massive bacterial proliferation and a sharp increase in pressure within the bile duct. This bacterial infection acts like a “bomb,” triggering a series of severe inflammatory reactions within the biliary system. Cholangitis commonly occurs in people aged 40-60, with a mortality rate of 20%-23%, which is even higher in the elderly.

Therefore, timely and effective treatment is crucial for reducing the mortality rate of this disease. For elderly patients, whose cardiopulmonary, hepatic, and renal functions are often compromised, they cannot tolerate complex open surgery. ERCP has become the preferred treatment method, allowing for faster normalization of bile drainage and reducing the absorption of bacteria and toxins into the body.

Technical Highlight: How Does ERCP Achieve Maximum Effect with Minimal Intervention?

ERCP (Endoscopic Retrograde Cholangiopancreatography) is a “no-incision” super-minimally invasive technique: The physician inserts a duodenoscope through the mouth, passes it through the esophagus and stomach to the descending part of the duodenum, locates the duodenal papilla, and then inserts a catheter through the papilla into the bile duct. Contrast medium is injected, and under X-ray fluoroscopy, the morphology, course, and any obstruction of the bile duct are observed. If obstructive factors like stones are found, further measures can be taken. 

Compared to traditional open surgery, ERCP requires no abdominal incision, resulting in minimal trauma and rapid recovery, making it particularly suitable for elderly patients or those with poor cardiopulmonary function. However, this technique demands exceptional operator experience, akin to “embroidering” within a 3 mm bile duct. Even a slight error can cause pancreatitis or perforation, truly a “lifeline” procedure.

Science Extension: Is Surgery Truly a “Forbidden Zone” for Elderly Patients?

Traditional belief holds that surgical risk is extremely high for patients over 80. However, modern medicine breaks this impasse through three major strategies:

Minimally Invasive Approach: Technologies like ERCP and vascular intervention minimize trauma.

Precision Anesthesia: Techniques such as cerebral oxygen saturation monitoring and target-controlled infusion reduce interference with the circulatory system.

Enhanced Recovery After Surgery (ERAS): Early postoperative feeding and multimodal analgesia shorten bed rest time and reduce the risk of thrombosis and infection.

Author: Department of Gastroenterology | Dr. Zhao Jiwei, Deputy Chief Physician

Professional Guidance: Department of Gastroenterology | Dr. Li Zijun, Chief Physician, Professor, Department Director