Uylas Ufuk, Tardu Ali, Kayaalp Cuneyt
İzmir SBÜ Tepecik Training and Research Hospital, General Surgery Department, İzmir, Turkey.
Bursa Yüksek İhtisas Training and Research Hospital, Department of Gastrointestinal Surgery, Bursa, Turkey.
Int J Surg Case Rep. 2021 Feb;79:459-461. doi: 10.1016/j.ijscr.2021.01.037. Epub 2021 Jan 28.
In liver cyst hydatid surgery, presence of cysto-biliary communication (CBC) is important for the prevention of postoperative morbidity. If cysto-biliary connections are not obvious, diagnosis is not easy. Intraoperative bile leakage test has been shown to reduce postoperative biliary complications by revealing occult CBCs. However, bile leakage testing in emergency conditions such as hydatid cyst perforation has not been experienced so far.
Here, a bile leakage test performed in a 23-year-old male patient undergoing emergency surgery due to the perforation of the hydatid liver cyst was presented. Following the treatment of perforated hydatid liver cyst and biliary peritonitis, a bile leakage test was performed. The common bile duct was cannulated with a 22G catheter, normal saline and parenteral lipid solution were given to demonstrate the CBCs, and leakage areas were suture ligated. The patient was discharged postoperatively without any problem.
We recommend detection and treatment of the CBCs even in emergency hydatid liver cyst surgery for prevention of postoperative biliary complications.
在肝包虫囊肿手术中,囊肿与胆管相通(CBC)对于预防术后并发症很重要。若囊肿与胆管的连接不明显,则诊断不易。术中胆汁渗漏试验已被证明可通过发现隐匿的CBC来减少术后胆道并发症。然而,迄今为止尚未有在诸如包虫囊肿穿孔等紧急情况下进行胆汁渗漏试验的经验。
在此,介绍了一名23岁男性患者,因肝包虫囊肿穿孔接受急诊手术时进行的胆汁渗漏试验。在治疗穿孔性肝包虫囊肿和胆汁性腹膜炎后,进行了胆汁渗漏试验。用22G导管插入胆总管,给予生理盐水和肠外脂质溶液以显示CBC,并对渗漏区域进行缝合结扎。患者术后顺利出院。
我们建议即使在急诊肝包虫囊肿手术中也应检测和处理CBC,以预防术后胆道并发症。