Another Post-Whipple Complication (chills/fever explained)
My mom (69f, stage 1, post-whipple) was hospitalized less than one month ago for an abscess that had formed in the post-Whipple surgical bed due to a small leak in a surgical connection. The symptoms that led to her ambulance ride to the ER included chills, involuntary shaking, fever, elevated heart rate, confusion, thirst, fatigue.
They treated the abscess with IV antibiotics. The surgeon had already opened up the incision a few weeks prior to allow the fluid to drain. (Please see my older posts for more detailed info).
In addition to the abscess, the CT scan had showed that necrotic tissue and inflammation were pinching the SMV.
When she was discharged from the hospital they prescribed oral antibiotics for 14 days. About 2 hours into our drive home from the hospital she had yet another episode of chills, fever, etc. I wasn’t expecting the episodes to continue after she received treatment and was discharged, so I called the surgeon who simply said, “it doesn’t sound like a change in her condition”. He believed the episodes were an inflammatory response to necrotic tissue.
Upon arriving home she was constipated for a few days and then began having loose stools.
During the follow-up visit the surgeon noted his concern regarding the pinched SMV and prescribed blood thinners. He was confident that the leak would continue draining from the open incision and heal itself. He informed me that he had intentionally packed the necrotic tissue there to protect healthy tissue in case of a leak at the connection site. He also instructed my mom to increase the amount of Creon she took with food hoping it would alleviate the loose stools.
Over the next 2 weeks the drainage slowly stopped. The wound looked very healthy and was healing nicely. But my mom continued to have episodes of chills/fever followed by extreme fatigue; her fever hovered around 99/100 and resolved with Tylenol. The surgeon still wasn’t concerned as her bloodwork continued trending in the right direction.
My dad and I started becoming suspicious that she was experiencing cholangitis, or “whipple attacks” minus the pain.
Over the past week the episodes increased in frequency, and the fevers began spiking to 102/103. Yesterday morning she experienced two back to back episodes and also had profuse diarrhea.
I called the surgical team, detailed the changes, and requested they order more labs, hepatic function panel testing, and a stool sample to test for C. Diff. Due to the higher temperatures of the fevers and increased frequency of the episodes they instructed us to go back to a local emergency room.
My poor mother was so upset when I told her we had to go back to the ER. I told her (essentially lied to her in hindsight which makes me feel pretty bad) that they probably would just run tests and send her home. I was hopeful I guess. Alas, she was admitted.
Concerned about sepsis, the local ER put her on IV antibiotics immediately.
This time the CT scan showed an infected clot in the SMV/Portal Vein (Septic Thrombophlebitis), shunting of the liver, and colonic thickening - later she was able to produce a stool sample and tested positive for C. Diff.
This morning she was transferred back to the hospital where she had the Whipple…she arrived about an hour ago. My dad and I are currently on our way out to see her now.
At the moment my relief about finally having some answers is overshadowing any negative emotions I have about the situation. I’m feeling hopeful that the medical team knows exactly what’s going on and will know how to treat it. The mystery episodes of chills and the toll it was taking on my mother were really hard to watch, and I was beginning to fear it was a new normal for her.
Of course, I know nothing is guaranteed with this disease and the recovery from such an intense surgery. As scary as it all is, at this moment I feel it’s going to be okay.
Now for the time being I just need to try to keep her spirits up.
Will post updates regarding progress and treatment.