Papadopoulou Ioanna, Fotiadis Nicos I, Ahmed Irfan, Thurley Peter, Hutchins Robert R, Fotheringham Tim
Department of Diagnostic Imaging, Barts and The London NHS Trust, The Royal London Hospital, London, E1 1BB, UK.
J Med Case Rep. 2011 Mar 14;5:103. doi: 10.1186/1752-1947-5-103.
Retrievable plastic biliary stents are usually inserted endoscopically. When endoscopic placement fails, radiological percutaneous transhepatic placement is indicated. We report the occurrence of a case of delayed duodenal perforation with abscess formation after radiological placement of a plastic stent. To the best of our knowledge, this is the first report of this complication after radiological stenting.
A 58-year-old Caucasian man had a mass 30 mm in size in the head of the pancreas and obstructive jaundice. He was referred for radiological insertion of plastic biliary stents after a failed endoscopic attempt. The procedure was uneventful, and the patient was discharged. Two weeks after the procedure, the patient presented with an acute abdomen and signs of sepsis. Computed tomography revealed erosion of the posterior duodenal wall from the plastic stent, and a large retroperitoneal abscess. The abscess was drained under computed tomography guidance, and the migrated stent was removed percutaneously with a snare under fluoroscopic guidance. Our patient had an uneventful recovery and was discharged after a week.
Late retroperitoneal duodenal perforation is a very rare but severe complication of biliary stenting with plastic stents. Gastroenterologists, surgeons and radiologists should all be aware of its existence, clinical presentation and management.
可回收塑料胆管支架通常通过内镜插入。当内镜放置失败时，则需进行放射学经皮肝穿刺放置。我们报告了1例塑料支架放射学放置后发生迟发性十二指肠穿孔并形成脓肿的病例。据我们所知，这是放射学支架置入术后该并发症的首例报告。
一名58岁的白种男性，胰头有一个30毫米大小的肿块，并伴有梗阻性黄疸。在内镜置入尝试失败后，他被转诊接受塑料胆管支架的放射学置入。手术过程顺利，患者出院。术后两周，患者出现急腹症和脓毒症体征。计算机断层扫描显示塑料支架侵蚀十二指肠后壁，并有一个巨大的腹膜后脓肿。在计算机断层扫描引导下引流脓肿，并在荧光透视引导下用圈套器经皮取出移位的支架。我们的患者恢复顺利，一周后出院。
晚期腹膜后十二指肠穿孔是塑料支架胆管置入术一种非常罕见但严重的并发症。胃肠病学家、外科医生和放射科医生都应了解其存在、临床表现及处理方法。
