Beard Jasna I, Murphy Sharif, Philips George
College of Medicine, University of Tennessee, Chattanooga, TN.
ACG Case Rep J. 2019 May 10;6(5):e00078. doi: 10.14309/crj.0000000000000078. eCollection 2019 May.
A 43-year-old man with a history of pedestrian-truck collision 18 months prior presented with right-sided abdominal pain and chills. His trauma consisted of orthopedic injuries and a grade 4 liver laceration. Surgical liver repair was complicated by a biloma requiring common bile duct stenting. Postendoscopy hemobilia led to extensive coiling of a hepatic artery pseudoaneurysm. Remaining hospitalization was relatively uneventful, and he was lost to follow-up. Repeat presentation was marked by leukocytosis and obstructive transaminitis. Computed tomography raised concern for a dilated 14-mm common bile duct with migrated coil mass near the pancreatic head. The patient underwent urgent endoscopic retrograde cholangiopancreatography with cholangioscopy and successful removal of a coil mass measuring approximately 4 × 3 cm without injury to the common bile duct or vascular structures. His pain was relieved, and he was discharged with a common bile duct stent and outpatient follow-up.
一名43岁男性，18个月前曾发生行人与卡车碰撞事故，现出现右侧腹痛和寒战。他的创伤包括骨科损伤和4级肝裂伤。肝手术修复后出现胆汁瘤，需要进行胆总管支架置入。内镜检查后发生胆道出血，导致肝动脉假性动脉瘤广泛盘绕。随后的住院过程相对平稳，但他失访了。再次就诊时表现为白细胞增多和梗阻性转氨酶升高。计算机断层扫描显示，胆总管扩张至14毫米，胰头附近有移位的线圈团块，令人担忧。患者接受了紧急内镜逆行胰胆管造影及胆管镜检查，成功取出了一个大小约为4×3厘米的线圈团块，未损伤胆总管或血管结构。他的疼痛得到缓解，带着胆总管支架出院并接受门诊随访。
