Asai Hajime, Shirota Chiyoe, Tainaka Takahisa, Makita Satoshi, Ogawa Katsuhiro, Okamoto Masamune, Yasui Akihiro, Takada Shunya, Hayashi Kaito, Nakagawa Yoichi, Katou Daiki, Ishii Hiroki, Utsunomiya Ami, Uchida Hiroo
Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Asian J Endosc Surg. 2025 Jan-Dec;18(1):e70122. doi: 10.1111/ases.70122.
Bile duct perforation is a rare, serious complication of congenital biliary dilatation (CBD). While traditionally managed with a two-stage surgical approach, recent reports suggest that one-stage, minimally invasive approaches may be feasible. We present the case of a 13-month-old female who developed bile duct perforation associated with a protein plug in the common channel. Following the correction of coagulopathy, emergency robotic surgery was performed, including bile duct excision and Roux-en-Y hepaticojejunostomy. Despite significant adhesions and an anatomical anomaly in which the right hepatic artery coursed anterior to the common hepatic duct, robotic dissection and reconstruction were safely completed. The postoperative course was uneventful, and the patient was discharged. This report highlights the feasibility and potential advantages of one-stage robotic surgery for CBD with perforation, even in the presence of active inflammation and vascular anomalies. Similar cases must be reported and evaluated to understand the indications and limitations of this approach.
胆管穿孔是先天性胆管扩张症（CBD）一种罕见的严重并发症。传统上采用两阶段手术方法进行治疗，但最近的报告表明，一期微创方法可能是可行的。我们报告一例13个月大的女性患者，其发生与共同通道内蛋白栓相关的胆管穿孔。在纠正凝血功能障碍后，进行了急诊机器人手术，包括胆管切除和Roux-en-Y肝空肠吻合术。尽管存在严重粘连以及右肝动脉走行于肝总管前方的解剖异常，但机器人手术分离和重建仍安全完成。术后过程顺利，患者出院。本报告强调了一期机器人手术治疗穿孔性CBD的可行性和潜在优势，即使存在活动性炎症和血管异常。必须报告和评估类似病例，以了解该方法的适应证和局限性。
