Malik Asad, Sato Kent T, Riaz Ahsun
Division of Interventional Radiology, Department of Radiology, Northwestern University, Chicago, Illinois.
Semin Intervent Radiol. 2023 Jul 20;40(3):294-297. doi: 10.1055/s-0043-1769768. eCollection 2023 Jun.
The gold-standard treatment of acute calculous cholecystitis is cholecystectomy. For patients not suitable for surgery, endoscopic or percutaneous techniques can be used for gallbladder decompression. The national percutaneous cholecystostomy rates have increased by 567% from 1994 to 2009*. Some of these patients are still not surgical candidates after the acute cholecystitis episode has resolved. Hence, it is crucial to have a management plan in place for such patients. There are several peroral endoscopic treatment options available, including ultrasound-guided transmural drainage, lithotripsy, and transpapillary stenting**. Furthermore, due to the advent of percutaneous biliary endoscopes, interventional radiology (IR) can now perform percutaneous lithotripsy and gallstone removal followed by cystic duct stenting. This method aims to internalize gallbladder drainage without the need for a long-term external cholecystostomy tube. Acute pancreatitis is a rare complication that can arise following interventions involving the biliary and cystic ducts. Acute pancreatitis can occur after retrograde ampullary manipulation during endoscopic retrograde cholangiopancreatography. However, this can sometimes happen after percutaneous antegrade interventions performed by IR. In this report, we will examine a rare complication that occurred in a patient with acute calculous cholecystitis: acute pancreatitis following percutaneous electrohydraulic lithotripsy with cystic duct stenting performed by IR.
急性结石性胆囊炎的金标准治疗方法是胆囊切除术。对于不适合手术的患者，可采用内镜或经皮技术进行胆囊减压。从1994年到2009年，全国经皮胆囊造瘘术的发生率增长了567%。在急性胆囊炎发作缓解后，其中一些患者仍然不适合进行手术。因此，为这类患者制定一个管理计划至关重要。有几种经口内镜治疗选择，包括超声引导下经壁引流、碎石术和经乳头支架置入术*。此外，由于经皮胆道内镜的出现，介入放射学（IR）现在可以进行经皮碎石术和胆结石清除，随后进行胆囊管支架置入术。这种方法旨在实现胆囊引流的内引流，而无需长期留置外部胆囊造瘘管。急性胰腺炎是一种罕见的并发症，可能在涉及胆管和胆囊管的干预后出现。在内镜逆行胰胆管造影术期间进行逆行壶腹操作后可能会发生急性胰腺炎。然而，这有时也可能发生在IR进行的经皮顺行干预之后。在本报告中，我们将研究一名急性结石性胆囊炎患者发生的一种罕见并发症：IR进行经皮电液压碎石术并置入胆囊管支架后发生的急性胰腺炎。
