Srinivasa Ravi Nara, Osher Matthew L, Murrey Douglas A, Fenlon Jordan Bruce, Brewerton Charles, Saad Wael E, Chick Jeffrey Forris Beecham
Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Health Systems, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
Department of Radiology, Western Michigan University School of Medicine, Kalamazoo, MI, USA.
Radiol Case Rep. 2017 Oct 2;12(4):790-793. doi: 10.1016/j.radcr.2017.09.013. eCollection 2017 Dec.
Patients with a Roux-en-Y gastric bypass may be challenging diagnostic and therapeutic dilemmas for gastroenterologists and endoscopists due to anatomic considerations. Pancreaticobiliary limb pathology is particularly difficult to diagnose from standard endoscopic approaches as it often requires double balloon enteroscopy. Percutaneous access and gastrostomy placement into the gastric remnant, however, is a commonly performed procedure by interventional radiology. This report describes the identification of duodenal perforation and Graham patch dehiscence in the pancreaticobiliary limb of a patient with a prior Roux-en-Y gastric bypass who had failed traditional endoscopic measures, using transgastric remnant interventional duodenoscopy and confirmed with methylene blue injection into a periduodenal abscess.
由于解剖学因素，接受Roux-en-Y胃旁路手术的患者对于胃肠病学家和内镜医师而言，在诊断和治疗方面可能存在挑战。胰胆支病变尤其难以通过标准内镜检查方法进行诊断，因为通常需要双气囊小肠镜检查。然而，经皮穿刺进入胃残端并放置胃造口术是介入放射科常用的操作。本报告描述了一名既往接受过Roux-en-Y胃旁路手术的患者，其胰胆支出现十二指肠穿孔和格雷厄姆补片裂开，传统内镜检查方法未能确诊，通过经胃残端介入十二指肠镜检查得以识别，并经向十二指肠周围脓肿注射亚甲蓝得以证实。
