Costi Renato, Zarzavadjian Le Bian Alban, Mita Maria Teresa, Brou Fulgence Kassi Assamoi, Sarli Leopoldo, Violi Vincenzo
Dipartimento di Scienze Chirurgiche, Università degli Studi di Parma, Parma, Italia; and Service de Chirurgie Digestive, Hôpital "Simone Veil", Eaubonne, France..
Service de Chirurgie Digestive, Hôpital "Simone Veil", Eaubonne, France.
Acta Biomed. 2018 Jun 15;89(2):254-259. doi: 10.23750/abm.v89i2.6721.
Pancreatic pseudocyst endoscopic drainage by pancreatogastrostomy "pigtail" drain placement is spreading worldwide, with high success-rate and low morbidity, and is increasingly performed as outpatient procedure. The paper reports an unusual very early complication of this procedure and discusses the peculiar aspects of this event in an outpatient setting.
The first case of a 56-year-old outpatient developing a postoperative diffused acute peritonitis by gastric juice spilling caused by the misplacement of the distal end of two transgastric drains not reaching the pseudocyst is reported. As the case was programmed as outpatient and acute peritonitis symptoms occurred eight hours postoperatively, the patient was discharged and rehospitalized. A review of the literature of rare perforative complications of pancreatogastrostomy is performed.
CT scan allowed the prompt diagnosis, as it showed massive pneumoperitoneum, free fluid collection, and pigtail drain misplacement. Emergency laparoscopy allowed the removal of the two misplaced drains and gastric reparation. The procedure lasted 65 minutes, mostly needed for lavage. The patient was discharged 5 days later and outcomes are unremarkable 7 months after the procedure.
The indication to endoscopic pancreatogastrostomy and its outpatient management should be carefully pondered. Pancreogastrostomy drain misplacement may cause a life-threatening acute peritonitis associated with early aspecific symptoms, resulting in a challenging situation, especially in an outpatient setting. CT-scan may allow prompt diagnosis and effective management by minimally invasive surgery.
通过放置“猪尾”引流管进行胰胃吻合术来引流胰腺假性囊肿，这种方法在全球范围内逐渐普及，成功率高且发病率低，越来越多地作为门诊手术进行。本文报告了该手术一种罕见的极早期并发症，并讨论了在门诊环境下这一事件的特殊情况。
报告了首例56岁门诊患者的病例，该患者因两根经胃引流管远端未到达假性囊肿而导致胃液外溢，术后发生弥漫性急性腹膜炎。由于该病例计划作为门诊手术，且急性腹膜炎症状在术后8小时出现，患者出院后再次入院。对胰胃吻合术罕见穿孔并发症的文献进行了回顾。
CT扫描有助于迅速诊断，因为它显示出大量气腹、游离液体聚集以及猪尾引流管位置不当。急诊腹腔镜检查使得能够取出两根位置不当的引流管并修复胃部。手术持续了65分钟，大部分时间用于冲洗。患者5天后出院，术后7个月情况良好。
内镜胰胃吻合术及其门诊治疗的适应证应仔细权衡。胰胃吻合术引流管位置不当可能导致危及生命的急性腹膜炎，并伴有早期非特异性症状，从而造成具有挑战性的情况，尤其是在门诊环境中。CT扫描可能有助于通过微创手术迅速诊断并进行有效治疗。
