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逆行胰管支架迁移至胆道,表现为胰十二指肠切除术(惠普尔手术)罕见的早期并发症。

Retrograde Pancreatic Duct Stent Migration into the Biliary Tract Presenting as a Rare Early Complication of Pancreaticoduodenectomy (Whipple Procedure).

作者信息

Helaly Mayar, Sriwi Dalia, Alkholaidi Wijdan S, Almamlouk Raghed, Elshaer Amany, Allaboon Ranem M, Hassan Lamma H, Khalifa Hisham, Al-Alem Ihssan

机构信息

College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.

Department of Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.

出版信息

Am J Case Rep. 2019 Dec 13;20:1864-1868. doi: 10.12659/AJCR.917297.

Abstract

BACKGROUND Pancreaticoduodenectomy (Whipple procedure) is an established surgical procedure for the treatment of carcinoma of the head of the pancreas. Modifications to this procedure include gastropancreaticoduodenectomy, which includes the removal of parts of the pancreas, duodenum, and stomach. Complications of surgery include fistula formation, failure of the anastomosis, and leak of pancreatic enzymes, which can be reduced by stenting the pancreatic duct. This report is of a rare complication of pancreaticoduodenectomy and describes a case of retrograde migration of a pancreatic duct stent into the biliary tract through the orifice of the hepaticojejunostomy. CASE REPORT A 50-year-old man with a history of gastric cancer, underwent gastropancreaticoduodenectomy. Surgery was complicated by displacement of the pancreatic stent to the biliary system, which resulted in postoperative obstructive jaundice and bile leakage from the hepaticojejunostomy between the hepatic duct and the jejunum. An endoscopy was performed and the stent was successfully retrieved. The patient recovered rapidly, the bile leakage resolved, the patient's jaundice resolved, and was discharged home with no further surgical complications. CONCLUSIONS A case is reported of a rare early complication of pancreaticoduodenectomy in a patient with gastric cancer. Endoscopy successfully retrieved the pancreatic duct stent that had migrated into the biliary tract through the orifice of the hepaticojejunostomy.

摘要

背景

胰十二指肠切除术(惠普尔手术)是治疗胰头癌的一种既定外科手术。该手术的改良术式包括胃胰十二指肠切除术,即切除部分胰腺、十二指肠和胃。手术并发症包括瘘管形成、吻合口失败以及胰酶渗漏,通过对胰管进行支架置入可减少这些并发症。本报告介绍了一例胰十二指肠切除术罕见并发症的病例,描述了胰管支架经肝空肠吻合口逆行移入胆道的情况。

病例报告

一名有胃癌病史的50岁男性接受了胃胰十二指肠切除术。手术的并发症是胰管支架移位至胆道系统,导致术后梗阻性黄疸以及肝管与空肠之间的肝空肠吻合口胆汁渗漏。进行了内镜检查并成功取出支架。患者恢复迅速,胆汁渗漏得到解决,黄疸消退,出院时无进一步手术并发症。

结论

报告了一例胃癌患者胰十二指肠切除术罕见的早期并发症病例。内镜检查成功取出了经肝空肠吻合口移入胆道的胰管支架。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4f2a/6930705/d782d932d4c8/amjcaserep-20-1864-g003.jpg

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