Third Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan. Kitakyushu 807-8555, Japan.
J UOEH. 2023;45(2):123-127. doi: 10.7888/juoeh.45.123.
A 57-year-old man visited our hospital for acute cholangitis due to common bile duct (CBD) stones in March 2021. Biliary stenting was performed without any complications. The cholangitis improved rapidly. He was re-hospitalized to treat the CBD stones in May 2021. Although endoscopic retrograde cholangiopancreatography was performed, endoscopy caused a perforation of the duodenal bulb. We successfully performed endoscopic closure of the duodenal defect using an over-the-scope clip (OTSC). Considering that mild CBD dilatation of 10 mm can carry an increased risk of stenosis after surgery, we decided to avoid surgery and perform a follow-up endoscopic treatment. He was re-hospitalized in July 2021. The endoscopy revealed OTSC in the anterior wall of the duodenal bulb and complete healing of the perforation. We carefully advanced the scope to the second portion of the duodenum while avoiding OTSC, and the ampulla of Vater was identified. We were then able to remove the stones without any complications. OTSC was effective in closing a duodenal perforation and enabled us to carry out the retreatment safely and successfully.
一位 57 岁男性因胆总管（CBD）结石于 2021 年 3 月来我院就诊，诊断为急性胆管炎。胆管支架置入术顺利，胆管炎迅速改善。2021 年 5 月，该患者因 CBD 结石再次入院。尽管进行了内镜逆行胰胆管造影术，但内镜检查导致十二指肠球部穿孔。我们使用经内镜逆行胰胆管造影术用的全覆膜金属支架（OTSC）成功地对十二指肠缺损进行了内镜封闭。考虑到术后 CBD 轻度扩张 10mm 会增加狭窄的风险，我们决定避免手术，进行内镜下随访治疗。2021 年 7 月，该患者再次入院。内镜检查显示十二指肠球部前壁有 OTSC，穿孔完全愈合。我们小心地将内镜推进到十二指肠第二段，避开 OTSC，识别出 Vater 壶腹。随后，我们能够安全、顺利地取出结石。OTSC 成功地封闭了十二指肠穿孔，使我们能够安全、成功地进行再次治疗。
