Bonner Brady Chapman, Brown Nicholas I, Joseph Varghese Pynadath, Chandrasegaram Manju Dashini
Department of General Surgery, The Prince Charles Hospital, Brisbane, QLD, Australia.
School of Medicine, The University of Queensland, Brisbane, QLD, Australia.
Case Rep Surg. 2018 Jan 21;2018:1609601. doi: 10.1155/2018/1609601. eCollection 2018.
We describe the course of an 84-year-old lady with acute calculous cholecystitis. She was unable to have a cholecystectomy due to multiple comorbidities including morbid obesity, type 2 diabetes, Guillain-Barrè syndrome, chronic sacral pressure ulcer, and severe cardiac disease. Conservative treatment with intravenous antibiotics was initially successful; however, she subsequently re-presented with an empyema of the gallbladder. She was readmitted for further intravenous antibiotics and underwent percutaneous gallbladder drainage. The patient did not want a permanent catheter for drainage, nor the prospect of repeat drainage procedures in the future for recurrent cholecystitis. Following a discussion of the rationale and risks involved with other minimally invasive techniques, she underwent cholecystoduodenal stent placement following disimpaction and removal of cystic duct stones. The procedure restored antegrade gallbladder drainage, and at 18 months she remains symptom-free from her gallbladder. Long-term management of recurrent cholecystitis in elderly comorbid patients commonly includes permanent cholecystostomy or repeated percutaneous gallbladder drainage, both of which can be poorly tolerated. Permanent cholecystoduodenal stenting is a reasonable alternative in carefully considered patients in whom the benefits outweigh the risks. We describe our experience with cholecystoduodenal stenting and discuss some of the concerns and considerations with this technique.
我们描述了一位84岁患有急性结石性胆囊炎女性的病程。由于多种合并症，包括病态肥胖、2型糖尿病、吉兰-巴雷综合征、慢性骶部压疮和严重心脏病，她无法进行胆囊切除术。最初采用静脉注射抗生素的保守治疗取得了成功；然而，她随后再次出现胆囊积脓。她再次入院接受进一步的静脉抗生素治疗，并接受了经皮胆囊引流术。患者既不想要用于引流的永久性导管，也不希望未来因复发性胆囊炎而进行重复引流手术。在讨论了其他微创技术的基本原理和风险后，在取出胆囊管结石并解除梗阻后，她接受了胆囊十二指肠支架置入术。该手术恢复了胆囊的顺行引流，18个月来她的胆囊一直没有症状。老年合并症患者复发性胆囊炎的长期管理通常包括永久性胆囊造口术或反复经皮胆囊引流术，这两种方法患者耐受性都较差。对于经过仔细评估、受益大于风险的患者，永久性胆囊十二指肠支架置入术是一种合理的替代方法。我们描述了我们在胆囊十二指肠支架置入术方面的经验，并讨论了该技术的一些问题和注意事项。
