Bibi Mário, Viana Susana, Leitão Cátia, Moço Rui, Eremina Yuliana O
Internal Medicine Department, Hospital Pedro Hispano, Porto, Portugal.
Gastroenterology Department, Hospital Pedro Hispano, Porto, Portugal.
Eur J Case Rep Intern Med. 2021 Sep 1;8(9):002811. doi: 10.12890/2021_002811. eCollection 2021.
We report the case of a 77-year-old-man with a history of type 2 diabetes mellitus who underwent endoscopic retrograde cholangiopancreatography (ERCP) because of a gallstone in the common bile duct. Thirty-six hours after the procedure, the patient developed persistent fever and epigastric pain associated with de novo jaundice. Massive haemolysis (with exuberant spherocytosis) occurred and patient died in 3 hours. was isolated in the blood cultures. Massive haemolysis associated with has a high mortality rate. Management involves a high index of suspicion after gastrointestinal procedures like ERCP, surgical consultation, antibiotic therapy, transfusion of red cell concentrates and, potentially, hyperbaric oxygen therapy.
Endoscopic retrograde cholangiopancreatography (ERCP) can be complicated by Clostridium perfringens bacteraemia with devastating consequences. infection should be suspected in an icteric, febrile patient with abdominal pain, especially if intravascular haemolysis is present.Management of intravascular haemolysis and inflammation in a patient following ERCP should be multidisciplinary, involving surgery when needed and potentially hyperbaric oxygen therapy; penicillin or penicillin-derived antibiotics associated with clindamycin or metronidazole are the mainstays of antibiotic therapy.
我们报告了一例77岁男性病例，该患者有2型糖尿病病史，因胆总管结石接受了内镜逆行胰胆管造影术（ERCP）。术后36小时，患者出现持续发热、上腹部疼痛并伴有新发黄疸。发生了大量溶血（伴有大量球形红细胞增多），患者在3小时内死亡。血培养分离出[具体细菌名称未给出]。与[具体细菌名称未给出]相关的大量溶血死亡率很高。处理措施包括在ERCP等胃肠道手术后保持高度怀疑，进行外科会诊、抗生素治疗、输注红细胞浓缩液，以及可能的高压氧治疗。
内镜逆行胰胆管造影术（ERCP）可能并发产气荚膜梭菌菌血症，后果严重。对于有黄疸、发热且腹痛的患者，尤其是存在血管内溶血时，应怀疑[具体细菌名称未给出]感染。ERCP术后患者血管内溶血和炎症的处理应多学科协作，必要时进行手术，可能还需要高压氧治疗；青霉素或青霉素类抗生素联合克林霉素或甲硝唑是抗生素治疗的主要手段。
