Al-Jawad Mohammad, Lbabidi Nour A, Nabhan Mohammad H, Sheikh Alan, Hamze Aya, Danial Aghyad K
University of Aleppo, Faculty of Medicine.
Department of General Surgery, University of Aleppo, Faculty of Medicine, Aleppo, Syria.
Ann Med Surg (Lond). 2024 Apr 29;86(8):4784-4787. doi: 10.1097/MS9.0000000000002104. eCollection 2024 Aug.
Gangrenous cholecystitis is a serious complication of untreated gallbladder inflammation, necessitating immediate intervention. The primary resolution involves cholecystectomy, the surgical removal of the gallbladder.The Billroth II gastrectomy, named after Theodor Billroth, addresses gastric conditions by removing a portion of the stomach and reconnecting the remaining section to the small intestine.Endoscopic retrograde cholangiopancreatography (ERCP) is a minimally invasive procedure that diagnoses and treats bile duct and pancreatic duct disorders, using an endoscope to access the ducts, administer contrast dye, and perform interventions like stone removal and stent placement. It aids in managing conditions such as bile duct stones, strictures, pancreatic tumors, and pancreatitis.
A 25-year-old male with a history of gastric ulcer and Billroth II anastomosis presented with right hypochondrium pain, fever, and vomiting. Examination and imaging indicated gallbladder edema, abscess, and fluid collection. Laparotomy revealed severe adhesions around the gallbladder, which were released, and an abscess was drained. Postsurgery, a biliary fistula was suspected, leading to the proposal of an ERCP procedure. During ERCP, a plastic stent was inserted to aid bile drainage.
Therapeutic ERCP effectively treats biliary exudate, including in patients with Billroth II gastrectomy. Using a side-viewing duodenoscope simplifies accessing Vater's papilla. This successful procedure had no complications, such as pancreatitis or bleeding, and the patient remained stable.
ERCP in patients with a prior Billroth II gastrectomy is a risky procedure with potential complications. However, it can be considered as an alternative to avoid additional surgery if performed by experienced specialists with the necessary equipment.
坏疽性胆囊炎是未治疗的胆囊炎症的严重并发症，需要立即干预。主要的解决方法是胆囊切除术，即通过手术切除胆囊。以西奥多·比尔罗特（Theodor Billroth）命名的比尔罗特二世胃切除术，通过切除部分胃并将剩余部分重新连接到小肠来治疗胃部疾病。内镜逆行胰胆管造影术（ERCP）是一种微创手术，用于诊断和治疗胆管和胰管疾病，通过内镜进入导管，注入造影剂，并进行诸如取石和放置支架等干预操作。它有助于处理胆管结石、狭窄、胰腺肿瘤和胰腺炎等病症。
一名有胃溃疡病史且接受过比尔罗特二世吻合术的25岁男性，出现右季肋部疼痛、发热和呕吐症状。检查和影像学检查显示胆囊水肿、脓肿和积液。剖腹手术发现胆囊周围有严重粘连，予以松解，并引流了脓肿。术后怀疑有胆瘘，因此建议进行ERCP手术。在ERCP手术过程中，插入了一个塑料支架以帮助胆汁引流。
治疗性ERCP能有效治疗胆汁渗出，包括接受过比尔罗特二世胃切除术的患者。使用侧视十二指肠镜便于进入十二指肠乳头。该手术成功且无胰腺炎或出血等并发症，患者病情保持稳定。
先前接受过比尔罗特二世胃切除术的患者进行ERCP手术是一项有风险的操作，存在潜在并发症。然而，如果由经验丰富的专家使用必要设备进行操作，可将其视为避免额外手术的一种替代方法。
