Tsema Ievgen, Slobodianyk Viktor, Rahushyn Dmytro, Myrhorodskiy Denys, Yurkiv Oleh, Dinets Andrii
Department of Abdominal Surgery, National Military Medical Clinical Center of Ministry of Defense of Ukraine, Kyiv, Ukraine.
Department of Surgery, Bogomolets National Medical University, Kyiv, Ukraine.
Clin Med Insights Case Rep. 2021 Aug 31;14:11795476211043067. doi: 10.1177/11795476211043067. eCollection 2021.
One of the methods for the biliary tree decompression in the case of Klatskin tumor is transpapillary stenting, which could be completed by stent migration in 4% to 10% of cases. Approximately half of the stent migrations are in the proximal direction. In this study, we reported a rare case of proximal trans-diaphragmatic stent migration to the lower lobe of the right lung with the formation of a biliary-bronchial fistula (BBF).
A 60-year-old woman was diagnosed with hilar cholangiocarcinoma (type 3B by Bismuth-Corlette) complicated by posthepatic jaundice. To relieve jaundice there were performed endoscopic retrograde cholangiopancreatography, endoscopic sphincterotomy, endobiliary stent placement (10 Fr, 150 mm). A restenting (11.5 Fr, 130 mm) was performed in 2.5 months due to endobiliary tube occlusion. In the next 2 months, coughing attacks and biliptysis have appeared in the patient. A CT scan showed penetration of the liver, diaphragm, and lower lobe of the right lung with the proximal part of the stent and caused BBF formation. Anti-inflammatory and antibacterial therapy was administrated for 14 days and BBF was closed. Stent retrieval from the right hemithorax and endobiliary restenting was performed in 9 months after primary stenting. During follow-up, appropriate positioning and functioning of the stent were observed.
BBF formation is a rare complication of endobiliary stenting, which can be successfully treated by anti-inflammatory and antibiotic therapy, followed by transpapillary stent retrieval.
对于肝门部胆管癌患者，经乳头支架置入术是胆管树减压的方法之一，在4%至10%的病例中可能会出现支架移位。大约一半的支架移位是向近端方向。在本研究中，我们报告了一例罕见的近端经膈肌支架移位至右肺下叶并形成胆支气管瘘（BBF）的病例。
一名60岁女性被诊断为肝门胆管癌（Bismuth-Corlette 3B型），并发肝后性黄疸。为缓解黄疸，进行了内镜逆行胰胆管造影、内镜括约肌切开术和胆管内支架置入（10Fr，150mm）。由于胆管内导管堵塞，在2.5个月后进行了再次支架置入（11.5Fr，130mm）。在接下来的2个月里，患者出现咳嗽发作和咯血。CT扫描显示支架近端穿透肝脏、膈肌和右肺下叶，导致BBF形成。给予抗炎和抗菌治疗14天，BBF闭合。在初次支架置入9个月后，从右半胸取出支架并进行胆管内再次支架置入。在随访期间，观察到支架位置合适且功能正常。
BBF形成是胆管内支架置入术的一种罕见并发症，通过抗炎和抗生素治疗，随后经乳头取出支架可成功治疗。
