Holtmann M H, Franzaring L, Kiesslich R, Thüroff J W, Galle P R, Neurath M F
Medizinische Klinik und Poliklinik, Johannes-Gutenberg-Universität Mainz.
Z Gastroenterol. 2006 Oct;44(10):1043-5. doi: 10.1055/s-2006-926771.
We report on a 67-year-old female patient who presented in July 2005 with sudden onset of pain in the right upper abdomen. The patient had undergone cholecystectomy in 1987. Because of recurrent complaints in the right upper abdomen, a pigtail stent was placed into the common hepatic duct in 2001. When the patients presented now, the laboratory tests including liver enzymes were within normal ranges. Endoscopic retrograde cholangiography, however, revealed a remaining 10-French, impacted double pigtail endoprosthesis that was obstructed by sludge as well as multiple giant bile duct stones of 20 to 30 mm in size. The giant stones could be finally removed by the combined use of ESWL and endoscopic techniques. This case demonstrates that impacted stents may favour the development of giant bile duct stones that may result in clinical symptoms only after prolonged periods of time.
我们报告了一位67岁的女性患者，她于2005年7月出现右上腹突发疼痛。该患者曾在1987年接受过胆囊切除术。由于右上腹反复出现不适，2001年在肝总管置入了一根猪尾支架。此次患者就诊时，包括肝酶在内的实验室检查结果均在正常范围内。然而，内镜逆行胆管造影显示，剩余一根10法式的、嵌顿的双猪尾内支架被胆泥阻塞，同时还有多个大小为20至30毫米的巨大胆管结石。最终，通过联合使用体外冲击波碎石术（ESWL）和内镜技术，成功取出了这些巨大结石。该病例表明，嵌顿的支架可能促使巨大胆管结石的形成，而这些结石可能在很长一段时间后才会导致临床症状。
