Yoo Byoung Kwan, Kim Jong Hyeok, Moon Hong Ju, Cheon Won Seok, Yoo Ji Youn, Kim Jong Pyo, Kim Kyoung Oh, Park Cheol Hee, Hahn Tae Ho, Yoo Kyo Sang, Park Sang Hoon, Lee In Jae, Park Choong Kee
Department of Internal Medicine, Hallym University College of Medicine, Anyang, Korea.
Korean J Gastroenterol. 2005 May;45(5):361-4.
Spontaneous perforation of the common bile duct (CBD) is a rare event in adults. Most cases of CBD perforation are iatrogenic after invasive procedures such as endoscopic retrograde cholangiopancreatography (ERCP) or cholecystectomy. We report a case of an 81-year-old woman who presented with severe right upper abdominal pain, fever, and chills. Abdominal CT showed multiple gallbladder and CBD stones and loculated fluid collection in the inferoposterior portion of the stomach. ERCP showed the leakage of contrast media into the peritoneal cavity from the CBD. We performed endoscopic sphincterotomy (EST) and endoscopic nasobiliary drainage (ENBD) to decompress the CBD instead of emergent surgical intervention. One week later, cholangiography via ENBD tube revealed that there was no more leakage of the contrast media from the CBD. We performed cholecystectomy, removal of the CBD stones after exploration of the CBD, and T tube insertion. The perforated site of the CBD was closed and there was no more fluid collection in the inferoposterior portion of the stomach. Medical treatment including endoscopic procedures was useful for healing of the perforated CBD.
胆总管自发性穿孔在成人中是一种罕见事件。大多数胆总管穿孔病例是在诸如内镜逆行胰胆管造影术（ERCP）或胆囊切除术等侵入性操作后发生的医源性穿孔。我们报告一例81岁女性病例，她出现严重的右上腹疼痛、发热和寒战。腹部CT显示胆囊和胆总管多发结石以及胃后下部有局限性液体积聚。ERCP显示造影剂从胆总管漏入腹腔。我们进行了内镜括约肌切开术（EST）和内镜鼻胆管引流术（ENBD）以减压胆总管，而非进行紧急手术干预。一周后，通过ENBD管进行的胆管造影显示胆总管不再有造影剂漏出。我们进行了胆囊切除术，在探查胆总管后取出胆总管结石，并插入T管。胆总管穿孔部位已闭合，胃后下部不再有液体积聚。包括内镜操作在内的内科治疗对穿孔的胆总管愈合是有效的。
