Ahlawat Sushil K, Haddad Nadim
Division of Gastroenterology, Dept. of Medicine, Georgetown University Hospital, Washington, DC, USA.
Acta Gastroenterol Belg. 2009 Jul-Sep;72(3):361-4.
Endoscopic ultrasound (EUS) is considered a safe procedure; however, rare deaths have been reported due to complications such as perforation of the gastrointestinal tract. Several factors including age, the presence or absence of cervical osteophytes or duodenal diverticula, history of difficult intubation with prior endoscopic procedure, endosonographer's inexperience, or EUS guided interventions such as the drainage of the pancreatic duct or pseudocyst and fine needle aspiration may increase the risk of EUS related perforation of the gastrointestinal tract. We report a patient with pancreatic mass who developed duodenal perforation during EUS and was treated successfully with an immediate closure of perforation using endoscopic clips combined with bowel rest and antibiotics. Based on our patient and others reported in the literature, immediate recognition and closure of perforation with endoscopic clips may be useful in the management of patients with EUS induced duodenal perforation. However, surgical consultation and close clinical monitoring is required in the management of these patients.
内镜超声检查（EUS）被认为是一种安全的检查方法；然而，已有因胃肠道穿孔等并发症导致罕见死亡的报道。包括年龄、是否存在颈椎骨质增生或十二指肠憩室、既往内镜检查时插管困难史、内镜超声检查医师经验不足，或EUS引导下的干预措施（如胰管或假性囊肿引流及细针穿刺抽吸）等多种因素，可能会增加EUS相关胃肠道穿孔的风险。我们报告一例胰腺肿块患者，其在EUS检查期间发生十二指肠穿孔，并通过内镜夹立即封闭穿孔，同时结合肠道休息和抗生素治疗而成功治愈。根据我们的患者以及文献中报道的其他病例，内镜夹立即识别并封闭穿孔可能对EUS诱发的十二指肠穿孔患者的管理有用。然而，在这些患者的管理中需要外科会诊和密切的临床监测。
