Two-stage treatment at KIMS Kondapur saves techie with pancreatic neuroendocrine tumour

Hyderabad: Chronic obstructive jaundice caused by rare pancreatic tumours poses a major clinical challenge, particularly when vital blood vessels are involved.

In such cases, long-term relief is often limited to temporary procedures, with definitive surgery considered unsafe due to the risk of massive bleeding and organ failure.

Patients are frequently subjected to repeated interventions over several years, without a permanent solution.

Case study of Hyderabad techie

One such patient, a 30-year-old software professional from Hyderabad, lived with persistent jaundice for eight years after being diagnosed with a slow-growing pancreatic neuroendocrine tumour.

As the tumour progressed, it compressed the bile duct, resulting in constant jaundice, recurrent vomiting, severe indigestion, intense itching, repeated infections and frequent hospital admissions, severely affecting his quality of life.

When surgery is ruled out

The case became increasingly complex as the tumour encased the portal vein, the main vessel supplying blood to the intestines.

This led to severe portal hypertension and the formation of multiple fragile collateral blood vessels. In this condition, even minor surgical manipulation can trigger uncontrollable bleeding, prompting several hospitals in India to declare the case inoperable.

For nearly seven years, the patient depended on metallic biliary stents to temporarily relieve the obstruction. Since these stents require replacement every five to six months, he underwent more than 24 ERCP procedures.

Despite repeated hospital visits and spending several lakhs of rupees, the relief was short-lived and his condition steadily worsened.

Limited options abroad

Seeking a permanent solution, the patient travelled to Heidelberg, Germany, where doctors suggested a high-risk surgery costing approximately Rs 1.5 crore, with a reported mortality risk of 20 per cent. Unable to proceed, he returned to India in a critical condition, with bilirubin levels of 28 mg and persistent fever.

A staged surgical approach at Hyderabad KIMS

The patient was eventually evaluated at KIMS Hospitals, Kondapur, where a multidisciplinary team led by Dr Ravula Phani Krishna, a Senior Consultant Surgical Gastroenterologist and Liver-Pancreas Specialist, devised a two-stage treatment plan after detailed assessment.

Explaining the approach, Dr Phani Krishna said the patient had approached KIMS as a last resort after exhausting all available options in India and abroad.

“This case demonstrates how complex conditions considered untreatable can be successfully managed in India with advanced planning, multidisciplinary expertise, and perseverance,” he said.

The initial step involved Percutaneous Transhepatic Biliary Drainage (PTBD) to stabilise the patient and control jaundice.

This was followed by a complex shunt surgery to divert intestinal blood flow to a renal vein, significantly reducing portal hypertension and shrinking the dilated collateral vessels.

Definitive surgery and outcome

Once the bleeding risk was reduced, the team performed a nearly 10-hour-long surgery to permanently relieve the bile duct and intestinal obstructions. The procedure was completed without significant blood loss.

The patient had an uneventful recovery and returned to his IT job within six months.

He has since been living without jaundice, bringing an end to an eight-year-long cycle of repeated procedures and hospitalisations.

Doctors say the case underscores the importance of careful planning and staged interventions in managing rare and high-risk hepato-pancreatobiliary conditions, particularly those traditionally labelled as inoperable.