Keith Briscoe farms a piece of land in southwestern Kansas that was handed down from generation to generation in his family. His great, great grandfather, a freed slave whose family members were buffalo soldiers, left Kentucky to homestead the property in the 1880s.
It was Keith's dream to continue improving the family farm and leave it to his children. However, serious health problems threatened to ruin those plans.
A complex case
In 2005, Keith took a trip to Mexico. During his visit, Keith developed intestinal problems that never resolved. He was diagnosed with ulcerative colitis requiring a total colectomy – surgical removal of his entire colon. He was just 21 years old.
For several years, Keith's health remained stable. But in 2012, he took a turn for the worse. The bile ducts leading from his liver to his small intestine became obstructed, causing pain, fatigue and jaundice. Keith's local family physician referred him to The University of Kansas Health System.
An individualized treatment plan
It was important that Keith be evaluated by a multidisciplinary team of specialists at an academic medical center. Hepatologist Ryan M. Taylor, MD, led the way.
"Keith had a rare liver disease called primary sclerosing cholangitis," Dr. Taylor says. "It can be really tricky because it manifests differently in every patient. In Keith's case, we worked to control infection, to drain bile as best as possible and manage nutrition."
Key to draining the bile on behalf of the diseased liver was the placement of a biliary decompression catheter. Interventional radiologist Steven Lemons, MD, performed the procedure, inserting a catheter through the skin and into the bile ducts that extend into the duodenum. This allowed bile to drain from the body, improving Keith's clinical condition as he waited for the inevitable liver transplant.
Dr. Lemons used ultrasound and fluroscopy – real time X-rays that show motion – to guide his placement of the catheter.
"Keith was living with a progressive disease, and the body's inability to drain bile causes discomfort as well as the risk of recurrent fever, chills and hyperbilirubinemia," Dr. Lemons says. "This procedure served as a bridge to transplant, improving Keith's condition and quality of life as he awaited a liver. It is a strong example of the collaboration among disciplines that enables our care team to provide complete care and create complex solutions for complex problems."