Perez Anthony R, Del Mundo Hans Jesper F, Viray Brent Andrew G, Abon Juan Carlos, Resurreccion Derek C
University of the Philippines Manila College of Medicine, Philippines.
University of the Philippines Manila Philippine General Hospital, Philippines.
Int J Surg Case Rep. 2021 Nov;88:106510. doi: 10.1016/j.ijscr.2021.106510. Epub 2021 Oct 16.
Interventional internal drainage of the biliary tract has become an established procedure for the temporary and definitive treatment of biliary obstruction due to malignant or benign disease. The complication rate is reported to be so low that when feasible, this technique is preferred over a surgical drainage procedure.
A 26-year old woman was referred to the hepatopancreaticobiliary surgery service due to severe abdominal pain for 3 days after undergoing endoscopic retrograde cholangiopancreatography (ERCP). She underwent biliary dilatation and stent insertion for obstructive jaundice secondary to biliary stricture from hepatobiliary tuberculosis. The patient underwent exploratory laparotomy, peritoneal lavage, duodenorrhaphy and tube jejunostomy for bilious peritonitis and duodenal perforation from biliary stent migration. The patient died one day post-operation due to septic shock from secondary bacterial peritonitis.
ERCP and other interventional endoscopic biliary interventions are increasingly being used for biliary obstruction. Despite the various complications which arise from these diagnostic and therapeutic modalities, complications are relatively uncommon. Duodenal perforation from biliary stent migration is a rare complication after undergoing ERCP and stenting. However, in patients presenting with severe pain and physical signs of acute abdomen after the procedure, it should always be a consideration.
Despite the relative safety of interventional techniques for biliary obstruction, complications like pancreatitis, hemorrhage and perforation may occur. Early recognition and high index of suspicion allows for early intervention with good outcomes. Duodenal perforation from stent migration can occur and when intervention is delayed may lead to morbidity and mortality.
介入性胆道内引流术已成为治疗恶性或良性疾病所致胆道梗阻的一种既定方法，可用于临时和确定性治疗。据报道，该手术的并发症发生率很低，因此在可行的情况下，此技术比外科引流手术更受青睐。
一名26岁女性在接受内镜逆行胰胆管造影术（ERCP）后因严重腹痛3天被转诊至肝胰胆外科。她因肝胆结核引起的胆管狭窄继发梗阻性黄疸而接受了胆道扩张和支架置入术。该患者因胆汁性腹膜炎和胆管支架移位导致十二指肠穿孔，接受了剖腹探查、腹腔灌洗、十二指肠修补术和空肠造瘘术。患者术后一天因继发性细菌性腹膜炎导致的感染性休克死亡。
ERCP和其他介入性内镜胆道干预措施越来越多地用于治疗胆道梗阻。尽管这些诊断和治疗方式会引发各种并发症，但并发症相对并不常见。胆管支架移位导致十二指肠穿孔是ERCP和支架置入术后罕见的并发症。然而，对于术后出现严重腹痛和急腹症体征的患者，应始终考虑到这种情况。
尽管介入技术治疗胆道梗阻相对安全，但仍可能发生胰腺炎、出血和穿孔等并发症。早期识别和高度怀疑有助于早期干预并取得良好效果。支架移位可导致十二指肠穿孔，若干预延迟可能导致发病和死亡。
