Fujita Naoki, Kamada Hideki, Nakabayashi Ryota, Yamashita Takuma, Mimura Shima, Yamana Hiroki, Kobayashi Kiyoyuki, Oshima Minoru, Okano Keiichi, Kobara Hideki
Department of Gastroenterology and Neurology Faculty of Medicine Kagawa University Kagawa Japan.
Sanuki Municipal Hospital Kagawa Japan.
DEN Open. 2025 Apr 11;5(1):e70112. doi: 10.1002/deo2.70112. eCollection 2025 Apr.
Endoscopic ultrasound-guided cyst drainage (EUS-CD) was performed for walled-off pancreatic necrosis. Computed tomography performed the next day showed that the tip of the external drainage tube was located in the transverse colon, confirming an accidental EUS-CD-associated complication of mis-puncture. A colonoscopy was performed to confirm the puncture site, which was identified as a defect measuring 2 mm in diameter. The external drainage tube was removed immediately via a guidewire. We intentionally retained the guidewire as a landmark for the puncture site in the colon. The defect was approximated using an endoclip under full vision, with the guidewire covered with surrounding mucosa. After removing the guidewire smoothly, complete closure was achieved with additional endoclips. Four days later, EUS-CD was successfully repeated, resulting in the resolution of the walled-off pancreatic necrosis. This is the first known case in which an accidental puncture of the transverse colon occurred during EUS-CD for walled-off pancreatic necrosis, and guidewire-guided clip closure of the colon contributed to troubleshooting.
针对包裹性胰腺坏死进行了内镜超声引导下囊肿引流（EUS-CD）。次日进行的计算机断层扫描显示，外引流管尖端位于横结肠内，证实了EUS-CD相关的意外穿刺并发症。进行了结肠镜检查以确认穿刺部位，发现是一个直径2毫米的缺损。通过导丝立即移除了外引流管。我们有意保留导丝作为结肠穿刺部位的标志物。在完全可视的情况下，使用内镜夹将缺损处拉拢，导丝被周围黏膜覆盖。顺利移除导丝后，再用内镜夹实现了完全闭合。四天后，成功再次进行EUS-CD，使包裹性胰腺坏死得到缓解。这是已知的首例在针对包裹性胰腺坏死进行EUS-CD时意外穿刺横结肠的病例，导丝引导下的结肠夹闭有助于解决问题。
