Hoshi Yuki, Ishii Satoru, Takizawa Tsukasa, Tamura Hikaru
Surgery, Nasu Red Cross Hospital, Otawara, JPN.
Cureus. 2023 Aug 10;15(8):e43310. doi: 10.7759/cureus.43310. eCollection 2023 Aug.
A 59-year-old man with a past medical history of gallstones was diagnosed with acute cholecystitis and received antibiotic treatment. He was discharged after ten days of hospitalization and was due to undergo laparoscopic cholecystectomy. Three months later, however, he had to be readmitted due to a recurrence of acute cholecystitis. Subsequently, laparoscopic reconstituting subtotal cholecystectomy was performed because Inflammation of the gallbladder was severe. At the first postoperative outpatient visit, the patient reported obstructive jaundice, and computed tomography (CT) scan revealed fluid collection in the hepatic bed and a missed common bile duct stone. Percutaneous transhepatic abscess drainage (PTAD) was performed on admission, and endoscopic stone removal was attempted the following day but was challenging due to a periampullary diverticulum. During laparotomy for stone extraction, the patient experienced prolonged shock and CT showed bleeding from the liver and massive right hemothorax. After open chest drainage and hemostasis, transcatheter arterial embolization (TAE) was performed. Such a case has never been reported before, and the PTAD tube should be handled cautiously.
一名有胆结石病史的59岁男性被诊断为急性胆囊炎并接受了抗生素治疗。住院十天后出院，计划接受腹腔镜胆囊切除术。然而，三个月后，他因急性胆囊炎复发再次入院。随后，由于胆囊炎症严重，进行了腹腔镜重建次全胆囊切除术。术后第一次门诊随访时，患者报告出现梗阻性黄疸，计算机断层扫描（CT）显示肝床有积液且遗漏了胆总管结石。入院时进行了经皮经肝脓肿引流（PTAD），次日尝试内镜取石，但由于壶腹周围憩室而颇具挑战性。在剖腹取石术中，患者出现长时间休克，CT显示肝脏出血和大量右侧血胸。在进行开胸引流和止血后，实施了经导管动脉栓塞术（TAE）。此前从未报道过此类病例，PTAD管的处理应谨慎。
