Zuber-Jerger I, Schoelmerich J, Kullmann F
Medizinische Klinik und Poliklinik I der Universität Regensburg.
Z Gastroenterol. 2006 Apr;44(4):319-22. doi: 10.1055/s-2005-858973.
A 62-year-old lady presented with fever and abdominal pain. History revealed cholecystectomy two years ago due to cholecystolithiasis, complicated by perforation of the common bile duct, leading to hepaticojejunostomy, jejunocholedochostomy, endoscopic retrograde insertion of two plastic stents and percutaneous drainage of bilioma. The patient was lost to follow-up until she presented two years later in the emergency room. ERC was performed. Both stents were occluded. After extraction dirty bile popped out. Injection of contrast medium showed stones in the remaining common bile duct and dilatation of the intrahepatic bile ducts and the interposed jejunum. After stone extraction a subphrenic intrahepatic fluid collection became visible when injecting contrast medium in the intrahepatic bile ducts. Pus was aspirated. The abscess was drained with a nasobiliary tube. Antibiotics were given. Temperature and CRP normalized. The nasobiliary tube was removed when the biliary fluid was clear. Recovery was uneventful with complete resolution of symptoms.
一位62岁女性因发热和腹痛前来就诊。病史显示，两年前因胆囊结石行胆囊切除术，并发胆总管穿孔，导致肝空肠吻合术、空肠胆总管吻合术、内镜逆行插入两个塑料支架及经皮引流胆汁瘤。该患者失访两年后因急诊再次就诊。行内镜逆行胰胆管造影（ERC）检查，发现两个支架均堵塞。取出支架后，有浑浊胆汁流出。注入造影剂显示，残余胆总管内有结石，肝内胆管及中间的空肠扩张。取石后，向肝内胆管注入造影剂时可见膈下肝内液性聚集。抽出脓液，用鼻胆管引流脓肿。给予抗生素治疗。体温和C反应蛋白（CRP）恢复正常。当胆汁清澈时拔除鼻胆管。患者症状完全缓解，康复过程顺利。
