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胃十二指肠动脉假性动脉瘤栓塞弹簧圈移位继发上行性胆管炎一例报告

Ascending Cholangitis secondary to migrated embolization coil of gastroduodenal artery pseudo-aneurysm a case report.

作者信息

Zaafouri Haithem, Hasnaoui Anis, Essghaeir Sonia, Haddad Dhafer, Sabbah Meriam, Bouhafa Ahmed, Kharrat Jamel, Ben Maamer Anis

机构信息

Department of General Surgery Habib Thameur Hospital, Ali Ben Ayed Street's 2037 Montfleury, Tunis, Tunisia.

Department of Radiology Habib Thameur Hospital, Tunis, Tunisia.

出版信息

BMC Surg. 2017 Mar 23;17(1):30. doi: 10.1186/s12893-017-0227-9.

Abstract

BACKGROUND

Gastroduodenalartery (GDA) pseudo-aneurysms are very rare. Their clinical importance lies in the eventuality of rupture, causing bleeding and ultimately exsanguination.

CASE PRESENTATION

We report the case of a man, with prior history of biliary surgery, presenting with haemobilia secondary to a rupture of GDA pseudo-aneurysm eroding the main bile duct. The patient was treated with coil embolization. This technique is considered to be safe. However, on the long term, some complications may occur. In our case, the patient presented with cholangitis subsequent to coil migration in the lower bile duct. This situation was managed using endoscopic retrograde cholangiopancreatography (ERCP) allowing coil extraction with favorable evolution.

CONCLUSIONS

GDA pseudo-aneurysms are very rare. Bleeding, secondary to the rupture of these lesions, is a serious complication that could lead to death. Diagnosis and treatment of ruptured GDA pseudo-aneurysms rely on angiography. This method is considered to be safe. Cholangitis secondary to coil migration in the main bile duct is exceedingly rare,but remains an eventuality that physicians should be cognizant of.

摘要

背景

胃十二指肠动脉(GDA)假性动脉瘤非常罕见。其临床重要性在于可能发生破裂,导致出血并最终引起失血性死亡。

病例报告

我们报告一例有胆道手术史的男性患者,因GDA假性动脉瘤破裂侵蚀主胆管继发胆道出血。该患者接受了弹簧圈栓塞治疗。这种技术被认为是安全的。然而,从长期来看,可能会出现一些并发症。在我们的病例中,患者在弹簧圈迁移至低位胆管后出现了胆管炎。通过内镜逆行胰胆管造影(ERCP)处理了这种情况,成功取出弹簧圈,病情好转。

结论

GDA假性动脉瘤非常罕见。这些病变破裂继发的出血是一种可能导致死亡的严重并发症。破裂的GDA假性动脉瘤的诊断和治疗依赖于血管造影。这种方法被认为是安全的。主胆管内弹簧圈迁移继发胆管炎极为罕见,但仍是医生应注意的一种可能情况。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0e3b/5363039/1d6ab8c4a247/12893_2017_227_Fig1_HTML.jpg

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