Emara Mohamed H, Elbatae Hassan E, Ali Reda F, Ahmed Mohammed H, Radwan Mohamed Said, Elhawary Abdulhamid
Hepatology, Gastroenterology, and Infectious Diseases Department, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt.
Surgery Department, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt.
Middle East J Dig Dis. 2022 Oct;14(4):473-477. doi: 10.34172/mejdd.2022.309. Epub 2022 Oct 30.
Bile duct injury (BDI) is a severe and sometimes life-threatening complication of cholecystectomy. Several series have described a 0.5% to 0.6% incidence of BDI during laparoscopic cholecystectomy. We received an emergency call from the operating theater by the surgery team to assess an iatrogenic BDI in a 58-year-old man with cirrhosis who presented for laparoscopic cholecystectomy. After many trials by endoscopic retrograde cholangiopancreatography (ERCP) the guide wire passed to the peritoneal cavity and failed to pass proximally. Laparoscopy resumed, and the surgeon tried to pass the flexible guide wire proximally unsuccessfully. Then, a decision to hold the sphincterotome by laparoscopy and passing it proximally in harmony with ERCP was taken, which was successful. A regular ERCP with 10F plastic stent insertion was carried out, and the perforation was secured by the inserted stent without any further surgical intervention. Laparoscopy-assisted ERCP may give new insights into the immediate repair of iatrogenic bile duct injuries.
胆管损伤（BDI）是胆囊切除术的一种严重且有时危及生命的并发症。多个系列研究描述了腹腔镜胆囊切除术中BDI的发生率为0.5%至0.6%。我们接到手术团队从手术室打来的紧急电话，评估一名58岁肝硬化男性患者在接受腹腔镜胆囊切除术时发生的医源性BDI。在内镜逆行胰胆管造影术（ERCP）多次尝试后，导丝进入腹腔但未能向近端通过。重新进行腹腔镜检查，外科医生试图将柔性导丝向近端通过但未成功。然后，决定通过腹腔镜固定括约肌切开刀并与ERCP协调将其向近端推进，这一操作取得成功。随后进行了常规的ERCP并插入10F塑料支架，插入的支架确保了穿孔部位，无需进一步的手术干预。腹腔镜辅助ERCP可能为医源性胆管损伤的即时修复提供新的见解。
