Fatal refractory cholangitis following dual stent placement in an elderly patient with advanced ampullary carcinoma: a case report.

An 89-year-old man with advanced ampullary carcinoma developed fatal cholangitis after sequentially placed biliary and duodenal stents. He presented with obstructive jaundice and underwent endoscopic retrograde cholangiopancreatography (ERCP) with plastic biliary stent placement, leading to clinical improvement. He was readmitted for malignant duodenal obstruction and received a metallic duodenal stent. Post-procedure, he developed severe cholangitis caused by multidrug-resistant (MDR) Escherichia coli and Pseudomonas aeruginosa. Despite percutaneous transhepatic cholangiographic drainage (PTCD) and broad-spectrum antibiotics, the patient died of septic shock. This case highlights the lethal risk of life-threatening cholangitis in elderly patients with dual stents, emphasizing the need for a proactive prevention strategy, which is proposed in the discussion.