Symeonidis Dimitrios, Bompou Efrosyni, Samara Athina A, Kissa Labrini, Tepetes Konstantinos
Department of Surgery, University Hospital of Larissa, Mezourlo, Larissa, Greece.
Surg J (N Y). 2022 Sep 2;8(3):e227-e231. doi: 10.1055/s-0042-1756284. eCollection 2022 Jul.
Acute pancreatitis can cause a wide variety of local complications, sometimes pretty unusual. In the present report, we present a rather unusual cause of biliary peritonitis on the background of acute pancreatitis. A 41-year-old female patient with biliary acute pancreatitis and concomitant choledocholithiasis required an urgent laparotomy due to signs of sepsis and peritoneal irritation after a trial of conservative management. During laparotomy, the diagnosis of biliary peritonitis was established. Surprisingly, a residual gallstone obstructing the common bile duct at the level of the ampulla was causing bile to reflux, through the common channel, into the main pancreatic duct and subsequently into a partially ruptured acute pancreatic necrotic collection. Dealing with the unexpected is a constant challenge for the surgical team dealing with acute pancreatitis patients. Although deferring surgical intervention during the course of acute pancreatitis, as much as possible, is the ideal strategy, this is not always possible. Deciding the treatment strategy based on the patients' clinical condition represents the most appropriate approach.
急性胰腺炎可引发多种局部并发症，有时颇为罕见。在本报告中，我们呈现了一例以急性胰腺炎为背景的相当罕见的胆汁性腹膜炎病因。
一名41岁女性患者，患有胆源性急性胰腺炎并伴有胆总管结石，在试行保守治疗后，因出现败血症体征和腹膜刺激征而需要紧急剖腹手术。在剖腹手术中，确诊为胆汁性腹膜炎。令人惊讶的是，一枚残留结石在壶腹水平阻塞胆总管，致使胆汁通过共同通道反流至主胰管，随后进入部分破裂的急性胰腺坏死灶。
应对意外情况对处理急性胰腺炎患者的外科团队而言始终是一项挑战。尽管在急性胰腺炎病程中尽可能推迟手术干预是理想策略，但这并非总能实现。根据患者的临床状况决定治疗策略才是最合适的方法。
