Kim Tae Hyung, Bae Hyun Jin, Hong Seung Goun
Department of Internal Medicine, SAM Anyang Hospital, Anyang, Korea.
Clin Endosc. 2020 Jan;53(1):97-100. doi: 10.5946/ce.2019.032. Epub 2019 Sep 3.
Endoscopic ultrasound (EUS)-guided gallbladder (GB) drainage has recently emerged as a more feasible treatment than percutaneous transhepatic GB drainage for acute cholecystitis. In EUS-guided cholecystostomies in patients with distended GBs without pericholecystic inflammation or prominent wall thickening, a needle puncture with tract dilatation is often difficult. Guidewires may slip during the insertion of thin and flexible drainage catheters, which can also cause the body portion of the catheter to be unexpectedly situated and prolonged between the GB and intestines because the non-inflamed distended GB is fluctuant. Upon fluoroscopic examination during the procedure, the position of the abnormally coiled catheter may appear to be correct in patients with a distended stomach. We experienced such an adverse event with fatal bile peritonitis in a patient with GB distension suggestive of malignant bile duct stricture. Fatal bile peritonitis then occurred. Therefore, the endoscopist should confirm the indications for cholecystostomy and determine whether a distended GB is a secondary change or acute cholecystitis.
内镜超声（EUS）引导下胆囊（GB）引流术最近已成为一种比经皮经肝胆囊引流术更可行的急性胆囊炎治疗方法。在对胆囊扩张但无胆囊周围炎症或明显壁增厚的患者进行EUS引导下胆囊造瘘术时，穿刺针穿刺并扩张通道往往很困难。在插入细而柔软的引流导管时，导丝可能会滑动，这也可能导致导管主体意外地位于胆囊和肠道之间并延长，因为未发炎的扩张胆囊是可波动的。在手术过程中进行荧光透视检查时，对于胃扩张的患者，异常盘绕的导管位置可能看起来是正确的。我们在一名提示恶性胆管狭窄的胆囊扩张患者中经历了这样一次导致致命性胆汁性腹膜炎的不良事件。随后发生了致命性胆汁性腹膜炎。因此，内镜医师应确认胆囊造瘘术的适应证，并确定扩张的胆囊是继发性改变还是急性胆囊炎。
