Mourad F H, Khalifeh M, Khoury G, Al-Kutoubi A
Department of Internal Medicine, American University of Beirut Medical Center, P.O. Box 113-6044 Beirut, Lebanon.
Surg Endosc. 2000 May;14(5):500-1. doi: 10.1007/s004640000128. Epub 2000 Apr 28.
Laparoscopic instrumentation of the common bile duct (CBD) via the transcystic route or through direct choledochotomy seems to be safe, but in rare cases, complications such as pancreatitis, bile duct damage, and hemorrhage from cystic artery may occur. We report an unusual complication with this approach. A 62-year-old man with gallbladder stones presented with obstructive jaundice, mild pancreatitis, and a dilated CBD. He underwent laparoscopic cholecystectomy with an intraoperative cholangiogram through the cystic duct. A small stone seen in the CBD was removed using a 6-Fr vascular Fogarty catheter. Two days later, he became jaundiced again with a rising bilirubin. An endoscopic retrograde cholangiogram showed a 1.5-cm round filling defect floating in a dilated CBD. A sphincterotomy was performed, and a balloon catheter was inflated proximally and pulled down. To our surprise, the filling defect was a crystal clear object, which we finally realized was a fully inflated Fogarty catheter balloon. The balloon spontaneously deflated while being caught with a basket. Surgeons should be aware of this possible complication, and every effort should be made to verify that the balloon still is in place after removal of the embolectomy catheter. Whether vascular embolectomy catheter balloons are appropriate for stone removal or more rigid balloons should be used needs further evaluation.
经胆囊途径或直接胆总管切开术进行腹腔镜胆总管（CBD）手术似乎是安全的，但在极少数情况下，可能会出现胰腺炎、胆管损伤和胆囊动脉出血等并发症。我们报告了这种手术方法的一种罕见并发症。一名62岁患有胆囊结石的男性出现梗阻性黄疸、轻度胰腺炎和胆总管扩张。他接受了腹腔镜胆囊切除术，并通过胆囊管进行了术中胆管造影。使用6F血管Fogarty导管取出了胆总管内可见的一颗小结石。两天后，他再次出现黄疸，胆红素升高。内镜逆行胆管造影显示在扩张的胆总管内有一个1.5厘米的圆形充盈缺损漂浮着。进行了括约肌切开术，并将球囊导管在近端充气后向下拉。令我们惊讶的是，充盈缺损是一个晶莹剔透的物体，我们最终意识到那是一个完全充气的Fogarty导管球囊。球囊在用网篮抓住时自行瘪了下去。外科医生应意识到这种可能的并发症，并且在取出取栓导管后应尽一切努力确认球囊是否仍在位。血管取栓导管球囊是否适合取石或是否应使用更硬的球囊需要进一步评估。
