Wu Xingda, Li Guichen, Liu Zhe
Department of Pancreatic-Billary Surgery, First Hospital of China Medical University, Shenyang, China.
Ann Transl Med. 2020 Dec;8(24):1690. doi: 10.21037/atm-20-7595.
Duodenal injury under endoscopic retrograde cholangiopancreatography (ERCP) is extremely rare. This study describes a case of duodenum perforation after biliary stenting under ERCP for the first time. A 67-year-old female patient was transferred to the emergency department of First Hospital of China Medical University after experiencing whole abdominal pain for 6 hours. The patient had received a biliary stent placement under ERCP at an outer hospital 6 days previously due to duodenal papillary occupy. During the operation, a small perforation caused by a biliary stent was found at the lateral side of the duodenum, but no biliary stent was found. Duodenal juice was flowing out from the perforation, Then, the perforation was opened obliquely, and an 8-cm portion of the biliary stent was removed. Gastrostomy, jejunostomy, and choledochotomy T-tube drainage procedures were subsequently performed. The patient recovered well and was discharged with the T-tube and the jejunal nutrition tube after 20 days. Four types of perforation under ERCP have been reported in previous literature, and this case report documents a rare complication from biliary stenting under ERCP. This case is different from the previous four types and can be called type V, which give general endoscopic doctors a serious warning.
内镜逆行胰胆管造影术（ERCP）相关的十二指肠损伤极为罕见。本研究首次描述了1例ERCP下胆道支架置入术后十二指肠穿孔的病例。一名67岁女性患者在全腹疼痛6小时后被转至中国医科大学附属第一医院急诊科。该患者6天前因十二指肠乳头占位在外院接受了ERCP下胆道支架置入术。术中发现十二指肠外侧有一个由胆道支架导致的小穿孔，但未发现胆道支架。十二指肠液从穿孔处流出，随后将穿孔斜行切开，取出了8厘米长的一段胆道支架。随后进行了胃造瘘术、空肠造瘘术和胆总管切开T管引流术。患者恢复良好，20天后带着T管和空肠营养管出院。既往文献报道了ERCP下的四种穿孔类型，本病例报告记录了ERCP下胆道支架置入术一种罕见的并发症。本病例与之前的四种类型不同，可称为Ⅴ型，这给广大内镜医生敲响了警钟。
