Pancreaticoduodenectomy for bile duct carcinoma of a patient undergoing hemodialysis.

A 69-year-old Japanese man underwent pancreaticoduodenectomy for the resection of carcinoma at lower part of the common bile duct. Hemodialysis had already begun to treat chronic renal failure. He had been admitted for obstructive jaundice due to the carcinoma four months earlier. The serum total bilirubin was then 38.5 mg/dL, and the serum creatinine was 7 mg/dL. Hemodialysis was performed the day before the operation, and on the 1st, 3rd, 5th, 7th postoperative day. A rapidly degrading synthetic protease inhibitor was used as an anti-coagulant in the dialyzer to prevent systemic bleeding during the first postoperative week. Heparin was used from the second week. The maximum discharge from the drains was 2,300mL on the 3rd postoperative day. The drip intravenous infusion was changed from 1,900mL to 3,300mL during the first week to maintain the same body weight as the preoperative weight. Fresh frozen plasma and partial plasma fraction were used to maintain the colloidal pressure in the vessels so body weight reflects the fluid volume in the vessels. The postoperative course was uneventful. We present herein a successful case of pancreaticoduodenectomy for a patient undergoing hemodialysis to maintain the same body weight.