Mandai Koichiro, Nakamura Shiho
Department of Gastroenterology, Kyoto Second Red Cross Hospital, Kyoto, JPN.
Cureus. 2024 Aug 16;16(8):e66983. doi: 10.7759/cureus.66983. eCollection 2024 Aug.
We present the case of an 82-year-old female with obstructive jaundice secondary to a malignant distal biliary stricture. Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) was performed. The presence of a giant hiatal hernia induced dynamic liver movement during respiration, leading to unstable scope positioning. Despite the successful placement of a long, partially covered metal stent from the left intrahepatic bile duct to the intra-abdominal stomach, computed tomography performed three days later revealed free air and an increased distance between the liver and stomach. A subsequent endoscopy confirmed impending stent migration into the abdominal cavity, necessitating the insertion of an additional metal stent through the existing stent's mesh. The presence of a giant hiatal hernia may be considered a relative contraindication for EUS-HGS due to dynamic movements of the stomach and liver during respiration, which can cause stent migration, increased air leakage, and difficulty in establishing a stable fistula between these organs.
我们报告一例82岁女性患者，因恶性远端胆管狭窄继发梗阻性黄疸。实施了内镜超声引导下肝胃吻合术（EUS-HGS）。巨大食管裂孔疝的存在导致呼吸时肝脏动态移动，致使内镜定位不稳定。尽管成功地从左肝内胆管至腹腔内胃置入了一枚长的、部分覆膜金属支架，但三天后进行的计算机断层扫描显示有游离气体，且肝脏与胃之间的距离增加。随后的内镜检查证实支架即将移入腹腔，因此需要通过现有支架的网孔再置入一枚金属支架。由于呼吸时胃和肝脏的动态移动，巨大食管裂孔疝的存在可被视为EUS-HGS的相对禁忌证，这会导致支架移位、漏气增加以及在这些器官之间建立稳定瘘管困难。
