背景:塑料胆道支架,内镜逆行胰胆管造影术后,可以自发地从胆总管脱位并迁移到远端肠。大多数迁移的胆道支架随着粪便的通过而被移除。然而,移位的胆道支架可引起肠穿孔,虽然很少,可能需要手术干预。最近,我们观察到由移位的胆道支架引起的结肠憩室穿孔,我们通过文献复习报道了这个病例。
方法:1个月前,一名74岁的男子在胆道支架置入术后出现严重的右下腹疼痛。
方法:腹部计算机断层扫描显示近端升结肠由移位的胆道支架穿孔,合并局限性腹膜炎。
方法:急诊诊断腹腔镜检查显示塑料胆道支架穿透了近端升结肠,并进行了右半结肠切除术。
结果:在病理检查中,经胆道支架证实结肠憩室穿孔。患者出院,没有任何其他并发症。
结论:内镜逆行胰胆管造影术内镜医师必须始终对原位胆道支架患者支架移位的可能性保持谨慎。在无症状患者的胆道支架从胆总管脱位的情况下,后续串行,腹部平片,并且需要进行体格检查,直到确认自发通过粪便。在提示腹膜炎的症状病例中,需要腹部计算机断层扫描扫描确认,应考虑早期干预。
BACKGROUND: Plastic endobiliary stents, after endoscopic retrograde cholangiopancreatography, can get spontaneously dislocated from the common bile duct and migrate intothe distal bowel. Most migrated biliary stents are removed with the passing of stool. However, migrated biliary stents can cause bowel perforation, albeit rarely, and surgical intervention may be required. Recently, we observed a colonic diverticular perforation caused by a migrated biliary stent, and we have reported this
case with a review of the literature.
METHODS: A 74-year-old man presented with severe right lower quadrant pain after biliary stent insertion 1month ago.
METHODS: Abdominal computed tomography revealed perforation of the proximal ascending colon by the migrated biliary stent, combined with localized peritonitis.
METHODS: Emergency diagnostic laparoscopic examination revealed penetration of the proximal ascending colon by the plastic biliary stent, and right hemicolectomy was performed.
RESULTS: On pathological examination, colonic diverticular perforation by the biliary stent was confirmed. The patient was discharged without any additional complications.
CONCLUSIONS: Endoscopic retrograde cholangiopancreatography endoscopists must always be cautious of the possibility of stent migration in patients with biliary stents in situ. In cases of biliary stent dislocation from the common bile duct in asymptomatic patients, follow-up with serial, plain abdominal radiographs, and physical examination is needed until confirmation of spontaneous passage through stool. In symptomatic cases suggesting peritonitis, abdominal computed tomography scan confirmation is needed, and early intervention should be considered.