胆道支架穿孔:病例报告与回顾

F. Tirelli, Paolo Mirco, P. Fransvea, G. Pepe, A. Tringali, M. D. Grezia, C. Lodoli, V. Cozza, A. Greca, G. Sganga
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摘要

内镜逆行胆管造影术(ERCP)在各种恶性和良性胰胆管疾病的治疗中具有关键作用。据报道,5%至10%的病例中胆道支架移位可导致肠穿孔。一位80岁的白人男性被转介到我们医院,试图在内镜下取出大块肝内结石;在ERCP期间,一次完全取出结石是不可能实现的,植入三个塑料胆道支架以促进结石大小的减少,并进行延迟胆道镜辅助碎石。在接下来的2天内,患者腹痛加重,无发热、恶心和呕吐。紧急计算机断层扫描显示由于胆道支架移位导致十二指肠穿孔。开腹手术后,直接缝合十二指肠病变。患者3天后因多器官衰竭死亡。5 - 15%的病例可能发生ercp相关并发症,胆道支架移位占这些病例的5 - 10%;不到1%的支架迁移导致肠穿孔,最常见于十二指肠。与支架相关的肠穿孔可能在临床上引起误解,早期诊断和治疗有时具有挑战性。十二指肠穿孔是发生在腹膜内还是腹膜后,在选择最佳治疗方法时应加以考虑。
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Perforation Due to Biliary Stent: Case Report and Review
Abstract Endoscopic retrograde cholangiopacreatography (ERCP) has a pivotal role for the management of various malignant and benign pancreatico-biliary disorders. Biliary stents migration is reported in 5 to 10% of the cases and can be responsible for bowel perforation. An 80-year-old Caucasian man was referred to our hospital for an attempt at endoscopic extraction of massive intrahepatic lithiasis; during ERCP, complete stone extraction in a single session was not achievable and three plastic biliary stents were inserted to promote stone size reduction and perform a delayed cholangioscopy-assisted lithotripsy. During the next 2 days, the patient developed worsening abdominal pain with no fever, nausea, and vomiting. An emergency computed tomography showed a duodenal perforation due to biliary stent migration. Upon laparotomy, a direct suture of the duodenal lesion was performed. The patient died 3 days later because of a multiorgan failure. ERCP-related complications may occur in 5 to 15% of the cases and biliary stent migration accounts for 5 to 10% of these cases; less than 1% of stents migration determines bowel perforation, most commonly in the duodenum. Stent-related bowel perforation can be clinically misleading and early diagnosis and treatment are sometimes challenging. Whether the duodenal perforation is intra- or retroperitoneal should be taken into account to choose the best therapeutic approach.
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