Department of General Surgery, Bursa Uludağ University Faculty of Medicine, Bursa-Türkiye.
Ulus Travma Acil Cerrahi Derg. 2023 Mar;29(3):443-447. doi: 10.14744/tjtes.2022.28923.
Endoscopic retrograde cholangiopancreatography (ERCP) has been a widely used procedure in the diagnosis and treatment of various pancreaticobiliary disorders. Although widely considered a safe procedure, ERCP is associated morbidity and occasional mortality. The most common complications include acute pancreatitis, hemorrhage, and duodenal perforation. Portal vein cannulation is a rare complication of ERCP. We described a case of placement of an endoscopic biliary stent in the portal vein during ERCP and sphinc-terotomy. A 54-year-old female patient underwent laparoscopic cholecystectomy with a pre-diagnosis of chronic cholecystitis with gallstones. She visited emergency unit with the complaint of jaundice and itching on the 4th post-operative day. On the magnetic res-onance cholangiopancreatography, the intrahepatic and the extrahepatic bile ducts were dilated and a 7.5×5.5 mm stone at common bile duct. Sphincterotomy was performed by ERCP, the stones were removed, and then a 10F 7 cm stent was installed. Abdominopelvic computed tomography (CT) was performed on the 4th day of ERCP in the patient whose fever and total bilirubin levels persisted at 5 mg/dL, considering cholangitic abscess and/or ERCP complication. On the CT, the proximal end of the stent in the common bile duct was observed to enter into the main portal vein and the tip was observed to be thrombosed. Therefore, it was decided to remove the stent endoscopically under operating room conditions. After the anesthesia induction, the stent was endoscopically removed by the gastroenterology team. The abdominal cavity of patient was explored laparoscopically in the during of stent removal. The patient did not experience hemodynamic instability and did not require transfusion during anesthesia but had melena once on the clinical follow-up. The patient was discharged with low molecular weight heparin and oral cephalosporin and was advised to return for polyclinic control. Doppler ultrasonography (USG) was performed to evaluate the thrombosis of the portal vein in the patient who had intermittent fever during the controls. Doppler USG revealed a thrombosed appearance in the main portal vein and its branches. The patient, who was in good general condition and had no abdominal pain, was switched to high-dose low molecular weight heparin and followed under the control of the gastroenterology and general surgery outpatient clinic. This rare life-threatening complication should always be kept in mind especially during the procedure and/or in the clinical follow-up of the patient.
经内镜逆行胰胆管造影术（ERCP）已广泛应用于各种胰胆疾病的诊断和治疗。尽管被广泛认为是一种安全的程序，但 ERCP 与发病率和偶尔的死亡率有关。最常见的并发症包括胰腺炎、出血和十二指肠穿孔。门静脉插管是 ERCP 的罕见并发症。我们描述了一例在 ERCP 和括约肌切开术中将内镜胆管支架放置在门静脉中的病例。一名 54 岁女性患者因慢性胆囊炎伴胆结石行腹腔镜胆囊切除术，术后第 4 天因黄疸和瘙痒就诊于急诊。磁共振胰胆管造影显示肝内和肝外胆管扩张，胆总管内有一个 7.5×5.5 毫米的结石。通过 ERCP 进行括约肌切开术，取出结石，然后安装 10F7cm 支架。考虑到胆管炎脓肿和/或 ERCP 并发症，患者在 ERCP 后第 4 天行腹部盆腔 CT 检查，其发热和总胆红素水平持续在 5mg/dL。在 CT 上，观察到胆总管内支架的近端进入主门静脉，尖端观察到血栓形成。因此，决定在手术室条件下经内镜取出支架。麻醉诱导后，由胃肠病学团队经内镜取出支架。在支架取出过程中，对患者进行腹腔镜下腹腔探查。患者在麻醉期间没有经历血流动力学不稳定，也不需要输血，但在临床随访中出现过一次黑便。患者出院时给予低分子肝素和口服头孢菌素，并建议返回门诊部进行复诊。为评估该患者在复诊期间间歇性发热时门静脉的血栓形成情况，对其进行了多普勒超声检查。多普勒超声显示主门静脉及其分支有血栓形成的表现。该患者一般情况良好，无腹痛，将其转换为高剂量低分子肝素，并在胃肠病学和普通外科门诊的控制下进行随访。这种罕见的危及生命的并发症应始终牢记，特别是在手术期间和/或患者的临床随访中。
