Ustündağ Yücel, Karakaya Kemal, Aydemir Selim
Department of Gastroenterology, Zonguldak Karaelmas University, School of Medicine, Zonguldak.
Turk J Gastroenterol. 2009 Dec;20(4):279-81. doi: 10.4318/tjg.2009.0027.
Endoscopic cannulation of the biliary tract may be challenging in cases with juxtapapillary, duodenal diverticula. A 70-year old woman admitted to the hospital with the diagnosis of choledocholithiasis and acute cholangitis. She was placed on antibiotic treatment and parenteral fluid resuscitation. On endoscopic retrograde cholangiopancreatography, the papilla could not be cannulated because of the duodenal diverticulum. Various attempts at biliary cannulation failed. Endoscopic clips were used for evertion and fixation of a partially everted papilla from the diverticulum and for securing it in an orientation that allowed direct cannulation of the biliary tree. Cholangiography demonstrated multiple calculi within the choledochus. She was discharged from the hospital on the 9th day following endoscopic retrograde cholangiopancreatography in good condition. With this report, we aimed to remind physicians that the clip assisted method is a safe and effective technique for pancreatic and/or biliary cannulation, and should be preferred in patients in whom cannulation is extremely difficult due to large periampullary diverticula..
对于伴有十二指肠乳头旁憩室的病例，内镜下胆管插管可能具有挑战性。一名70岁女性因胆总管结石和急性胆管炎入院。她接受了抗生素治疗和肠外液体复苏。在内镜逆行胰胆管造影术中，由于十二指肠憩室，乳头无法插管。多次胆管插管尝试均失败。内镜夹用于将部分外翻的乳头从憩室中翻出并固定，并将其固定在允许直接插管进入胆管树的方向。胆管造影显示胆总管内有多个结石。在内镜逆行胰胆管造影术后第9天，她状况良好出院。通过本报告，我们旨在提醒医生，夹子辅助方法是一种安全有效的胰胆管插管技术，对于因壶腹周围大憩室导致插管极其困难的患者应优先选用。
