Kikuchi Satoru, Kubota Tetsushi, Kuroda Shinji, Nishizaki Masahiko, Kagawa Shunsuke, Kato Hironari, Okada Hiroyuki, Fujiwara Toshiyoshi
Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
Clin Endosc. 2019 Jul;52(4):373-376. doi: 10.5946/ce.2018.134. Epub 2019 Feb 15.
Endoscopic ultrasound (EUS)-guided transgastric drainage has been performed as a less invasive procedure for pancreatic fistulas and intra-abdominal abscesses occurring after surgery in recent years. However, there are no reports of EUS-guided transgastric drainage of intra-abdominal abscesses following gastrectomy. This case report describes 2 patients who developed an intra-abdominal abscess following gastrectomy and underwent EUS-guided transgastric drainage. Both patients underwent laparoscopy-assisted distal gastrectomy with Billroth-I reconstruction for gastric cancer. The intra-abdominal abscesses were caused by postoperative pancreatic fistula that developed following gastrectomy. One patient underwent naso-cystic drainage and the other underwent only a needle puncture of the abscess cavity. EUS-guided drainage was performed safely and effectively, although 1 patient developed gastroduodenal anastomotic leakage related to this procedure. In summary, EUS-guided transgastric drainage is safe and technically feasible even in post-gastrectomy patients. However, it is necessary to be careful if this procedure is performed in the early period following gastrectomy.
近年来，内镜超声（EUS）引导下经胃引流已作为一种侵入性较小的手术，用于治疗术后发生的胰瘘和腹腔内脓肿。然而，尚无胃切除术后腹腔内脓肿的EUS引导下经胃引流的报道。本病例报告描述了2例胃切除术后发生腹腔内脓肿并接受EUS引导下经胃引流的患者。两名患者均接受了腹腔镜辅助远端胃癌根治术及毕Ⅰ式重建术。腹腔内脓肿由胃切除术后发生的术后胰瘘引起。一名患者接受了鼻胆管引流，另一名患者仅对脓肿腔进行了穿刺。EUS引导下的引流安全有效，尽管有1例患者因该手术出现了胃十二指肠吻合口漏。总之，即使在胃切除术后患者中，EUS引导下经胃引流也是安全且技术上可行的。然而，在胃切除术后早期进行该手术时需要谨慎。
