Department of Gastroenterology, National Hospital Organization Ureshino Medical Center, Ureshino, Japan.
Division of Gastroenterology, Department of Internal Medicine, Saga University, Saga, 849-8501, Japan.
Clin J Gastroenterol. 2022 Feb;15(1):157-163. doi: 10.1007/s12328-021-01544-x. Epub 2021 Oct 29.
An 86-year-old woman presented with a history of endoscopic papillary sphincterotomy for bile duct stones and diverticulitis. The patient was admitted as an emergency case of acute cholangitis due to choledocholithiasis, underwent endoscopic bile duct stenting, and was discharged with a plan for endoscopic lithotripsy. One month later, the patient was readmitted owing to abdominal pain. Abdominal computed tomography at admission showed that the bile duct stent had migrated to the sigmoid colon and the presence of a small amount of extraintestinal gas, suggesting a colonic perforation. Lower gastrointestinal endoscopy showed adhesions and intestinal stenosis in the sigmoid colon, probably after diverticulitis, and the bile duct stent that had perforated the same site. The stent was removed and endoscopic closure of the perforation was performed using an over-the-scope clip. Abdominal computed tomography 8 days after the closure showed no extraintestinal gas. The patient resumed eating and was discharged on the 14th day of admission. There was no recurrence of abdominal pain. Endoscopic closure of sigmoid colon perforation due to bile duct stent migration using an over-the-scope clip has not been reported thus far, and it may be a new treatment option in the future.
一位 86 岁的女性因胆管结石和憩室炎而行内镜下乳头括约肌切开术。因胆总管结石导致急性胆管炎，该患者急诊入院，行内镜胆管支架置入术，计划行内镜下碎石术。1 个月后，因腹痛再次入院。入院时的腹部 CT 显示胆管支架已迁移至乙状结肠，且存在少量肠外气体，提示结肠穿孔。下消化道内镜检查显示乙状结肠存在粘连和肠狭窄，可能是憩室炎后发生的，且胆管支架也穿孔至同一部位。支架被取出，并使用经内镜用的全覆膜可回收结扎夹对穿孔进行内镜下封闭。封闭后 8 天的腹部 CT 显示无肠外气体。患者开始进食，并于入院第 14 天出院。此后未再出现腹痛。使用经内镜用的全覆膜可回收结扎夹对胆管支架迁移导致的乙状结肠穿孔进行内镜下封闭目前尚未见报道，未来可能成为一种新的治疗选择。
