Takada Yoshihisa, Ishikawa Takuya, Yamao Kentaro, Mizutani Yasuyuki, Iida Tadashi, Uetsuki Kota, Kawashima Hiroki
Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65, Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8560, Japan.
Department of Endoscopy, Nagoya University Hospital, Nagoya, Japan.
Clin J Gastroenterol. 2025 Feb;18(1):169-175. doi: 10.1007/s12328-024-02067-x. Epub 2024 Nov 22.
A 73-year-old man underwent upper gastrointestinal endoscopy for abdominal pain, which revealed an ampullary adenoma with no obvious extension into the bile or pancreatic ducts. Endoscopic papillectomy (EP) was performed and a 5-Fr 5-cm stent was placed in the pancreatic duct. The patient developed acute pancreatitis on postoperative day (POD) 1 and contrast-enhanced computed tomography performed on POD 2 revealed that the proximal end of the stent had migrated into the retroperitoneum, forming a pancreatic fistula. Stent removal and endoscopic nasopancreatic drainage were performed and the pancreatitis rapidly improved. The tumor was completely resected and after approximately three years of follow-up, no tumor recurrence or acute pancreatitis was observed.Retrospectively, the inferior branch of the pancreatic duct was prominent on pancreatography at the time of EP and the proximal end of the stent had dislocated into the inferior branch. The stent subsequently moved proximally, which could have caused pancreatitis and pancreatic fistula. The morphology of the pancreatic duct should be carefully monitored during stenting. Selecting a stent that matches each patient's specific pancreatic duct morphology may help physicians minimize the risk of adverse outcomes.
一名73岁男性因腹痛接受上消化道内镜检查，结果显示为壶腹腺瘤，未明显侵犯胆管或胰管。进行了内镜下乳头切除术（EP），并在胰管内放置了一根5Fr、5厘米长的支架。患者在术后第1天发生急性胰腺炎，术后第2天进行的增强计算机断层扫描显示支架近端已移入腹膜后，形成胰瘘。取出支架并进行内镜下鼻胰管引流，胰腺炎迅速好转。肿瘤被完全切除，经过约三年的随访，未观察到肿瘤复发或急性胰腺炎。回顾性分析，EP时胰管造影显示胰管下支明显，支架近端已脱入下支。支架随后向近端移动，这可能导致了胰腺炎和胰瘘。在放置支架过程中应仔细监测胰管形态。选择与每位患者特定胰管形态相匹配的支架可能有助于医生将不良后果的风险降至最低。
