Obana Takashi, Yamasaki Shuuji
Department of Gastroenterology, Kyojinkai Komatsu Hospital, Neyagawa, Japan.
Case Rep Med. 2016;2016:5249013. doi: 10.1155/2016/5249013. Epub 2016 Sep 6.
Here, we present a case of malignant biliary tract obstruction with severe obesity, which was successfully treated by endoscopic ultrasonography-guided biliary drainage (EUS-BD). A female patient in her sixties who had been undergoing chemotherapy for unresectable pancreatic head cancer was admitted to our institution for obstructive jaundice. She had diabetes mellitus, and her body mass index was 35.1 kg/m. Initially, endoscopic retrograde cholangiopancreatography (ERCP) was performed, but bile duct cannulation was unsuccessful. Percutaneous transhepatic biliary drainage (PTBD) from the left hepatic biliary tree also failed. Although a second PTBD attempt from the right hepatic lobe was accomplished, biliary tract bleeding followed, and the catheter was dislodged. Consequently, EUS-BD (choledochoduodenostomy), followed by direct metallic stent placement, was performed as a third drainage method. Her postprocedural course was uneventful. Following discharge, she spent the rest of her life at home without recurrent jaundice or readmission. In cases of severe obesity, we consider EUS-BD, rather than PTBD, as the second drainage method of choice for distal malignant biliary obstruction when ERCP fails.
在此，我们报告一例患有严重肥胖症的恶性胆道梗阻病例，该病例通过内镜超声引导下胆道引流术（EUS - BD）成功得到治疗。一名60多岁的女性患者因不可切除的胰头癌正在接受化疗，因梗阻性黄疸入住我院。她患有糖尿病，体重指数为35.1kg/m²。最初进行了内镜逆行胰胆管造影术（ERCP），但胆管插管未成功。经皮经肝胆道引流术（PTBD）从左肝胆管树进行也失败了。尽管第二次尝试从右肝叶进行PTBD成功了，但随后出现了胆道出血，导管移位。因此，作为第三种引流方法，进行了EUS - BD（胆总管十二指肠吻合术），随后直接置入金属支架。她术后恢复过程顺利。出院后，她在家中度过余生，未出现黄疸复发或再次入院情况。在严重肥胖的病例中，当ERCP失败时，我们认为EUS - BD而非PTBD是远端恶性胆道梗阻的第二种首选引流方法。
