Zuber-Jerger I, Kullmann F
Department of Internal Medicine I, University of Regensburg, 93042 Regensburg, Germany.
Dig Liver Dis. 2006 Dec;38(12):930-1. doi: 10.1016/j.dld.2006.07.102. Epub 2006 Sep 18.
A 47-year-old patient presented with jaundice. Laboratory examinations confirmed cholestasis. The patient had a long history of chronic pancreatitis. Subsequently, cholecystectomy and a duodenum-preserving resection of the pancreatic head (Frey's surgery) had been performed. Endoscopic retrograde holangiography was done. The endoscope was inserted the normal way to the untouched papilla vateri. After injection of contrast medium, only the side-to-side choledocho-jejunal anastomosis but not the common bile duct could be visualized because the catheter spontaneously slipped into the jejunum via the side-to-side choledocho-jejunal anastomosis. After introducing a catheter percutaneously into the intrahepatic bile duct system, a long stenosis of the common bile duct could be visualized. It was possible to overcome the stenosis with a wire, but the wire also dislocated into the jejunum via the side-to-side choledocho-jejunal anastomosis and could not be placed through the papilla into the duodenum. The problem was solved in a tricky way: A wire was introduced into the common bile duct via the papilla and placed into the duodenum. A loop was brought in percutaneously and was also placed in the jejunum. With the loop, the wire was grabbed and taken out percutaneously. Now a biliary metal stent could be positioned correctly over the wire to expand the stenosis. After the procedure jaundice was cured quickly. The further course was uneventful with complete recovery.
一名47岁患者出现黄疸。实验室检查证实存在胆汁淤积。该患者有慢性胰腺炎病史。随后进行了胆囊切除术和保留十二指肠的胰头切除术（弗雷氏手术）。进行了内镜逆行胆管造影。内镜按常规方式插入未受影响的 Vater 乳头。注射造影剂后，仅能看到胆管空肠侧侧吻合口，而看不到胆总管，因为导管通过胆管空肠侧侧吻合口自行滑入空肠。经皮将导管插入肝内胆管系统后，可见胆总管有一段长段狭窄。用导丝可以克服狭窄，但导丝也通过胆管空肠侧侧吻合口脱位进入空肠，无法通过乳头放入十二指肠。问题以一种巧妙的方式解决：通过乳头将导丝引入胆总管并放入十二指肠。经皮引入一个圈套器，也将其放置在空肠内。用圈套器抓住导丝并经皮取出。现在可以在导丝上正确放置一个胆道金属支架以扩张狭窄。术后黄疸迅速消退。后续病程顺利，患者完全康复。
