Yasuhara Yukitaka, Shimamoto Nana, Tsukinaga Shintaro, Kato Masayuki, Sumiyama Kazuki
Faculty of Medicine the Jikei University School of Medicine Tokyo Japan.
Department of Endoscopy the Jikei University School of Medicine Tokyo Japan.
DEN Open. 2021 Nov 24;2(1):e77. doi: 10.1002/deo2.77. eCollection 2022 Apr.
Endoscopic ultrasound-guided biliary drainage (EUS-BD) has become popular as a new drainage technique for malignant biliary strictures. Although EUS-BD has been reported to show high technical and clinical success rates, the rate of adverse events is 15%. In particular, peritonitis, which is generally caused by bile leakage from the aspiration side during the procedure and occurs within a few days after EUS-BD, needs to be considered as it can be fatal. In the present case, a jaundiced patient presented with unresectable pancreatic adenocarcinoma. Due to duodenal invasion, we performed EUS-guided hepaticogastrostomy for biliary drainage. After the procedure, jaundice improved, and abdominal computed tomography (CT) showed only a small amount of air in the intrahepatic bile duct. However, 7 days after the procedure, the patient developed fever, and clinical findings indicated peritonitis. Abdominal CT showed food in the stomach accompanied by the appearance of perihepatic free air, with increased air in the intrahepatic bile duct. The duodenal stent insertion settled the peritonitis and improved the perihepatic free air and the air in the intrahepatic bile duct through the discharge of food from the stomach. To date, no case of tardive peritonitis associated with air leakage after EUS-BD has been reported. We noted that even if there was no evidence of bile leakage after EUS-BD, the possibility of tardive peritonitis due to gradual air leakage from the stent implantation side of the stomach should be considered, and careful follow-up is needed.
内镜超声引导下胆道引流术（EUS-BD）作为一种治疗恶性胆管狭窄的新型引流技术已逐渐普及。尽管有报道称EUS-BD具有较高的技术成功率和临床成功率，但其不良事件发生率为15%。特别是腹膜炎，通常由操作过程中抽吸侧胆汁渗漏引起，在EUS-BD术后数天内发生，因其可能致命而需要引起重视。在本病例中，一名黄疸患者被诊断为不可切除的胰腺腺癌。由于十二指肠受侵，我们进行了EUS引导下肝胃吻合术以进行胆道引流。术后黄疸有所改善，腹部计算机断层扫描（CT）显示肝内胆管仅有少量气体。然而，术后7天，患者出现发热，临床检查提示腹膜炎。腹部CT显示胃内有食物，伴有肝周游离气体出现，肝内胆管气体增多。十二指肠支架置入术使腹膜炎得到缓解，并通过胃内食物排出改善了肝周游离气体和肝内胆管气体情况。迄今为止，尚未有关于EUS-BD术后迟发性腹膜炎伴气体渗漏的病例报道。我们注意到，即使EUS-BD术后没有胆汁渗漏的证据，也应考虑到由于胃支架置入侧逐渐漏气导致迟发性腹膜炎的可能性，需要进行密切随访。
