Cicerone Ottavia, Di Gioia Giulio, Pajola Maria, Gallotti Anna, D'Agostino Antonio Mauro, Cionfoli Nicola, Corti Riccardo, Quaretti Pietro, Maestri Marcello
Dipartimento di Scienze Clinico-Chirurgiche, Diagnostiche e Pediatiche, University of Pavia, 27100 Pavia, Italy.
Radiologia, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy.
Reports (MDPI). 2024 Nov 9;7(4):95. doi: 10.3390/reports7040095.
: Biliary tract injuries are a recognized complication of laparoscopic cholecystectomy. Early diagnosis and prompt management are crucial to minimize complications such as bile leaks, strictures, and fistula formation. This case report highlights the use of a biodegradable biliary stent in managing a complex biliary injury and discusses the impact of delayed diagnosis on treatment outcomes. : We present the case of a 30-year-old male who sustained a Strasberg E2 biliary tract injury during a laparoscopic cholecystectomy. Initially misdiagnosed, the injury was only recognized on the fourth postoperative day. The patient underwent a Roux-en-Y hepaticojejunostomy and subsequently developed a postoperative biliary fistula, which was managed with percutaneous drainage. A biodegradable biliary stent was later placed to address a stricture and minimize the need for future interventions. One year later, the patient presented with symptoms of cholangitis, and radiological findings revealed a narrowing of the biliary lumen. The stricture was resolved and an endoscopic gastrojejunal shunt was placed to prevent further complications. The patient is currently in good condition with no signs of further complications. : This case emphasizes the importance of early diagnosis in managing biliary tract injuries and highlights the potential of biodegradable stents to reduce the need for repeat interventions. Despite a delayed diagnosis necessitating complex surgical procedures, the use of a biodegradable stent proved effective in managing postoperative complications. Further studies are needed to evaluate the long-term efficacy of biodegradable stents in similar clinical scenarios.
胆道损伤是腹腔镜胆囊切除术公认的并发症。早期诊断和及时处理对于将胆漏、狭窄和瘘管形成等并发症降至最低至关重要。本病例报告强调了可生物降解胆道支架在处理复杂胆道损伤中的应用,并讨论了延迟诊断对治疗结果的影响。
我们报告一例30岁男性患者,在腹腔镜胆囊切除术中发生Strasberg E2型胆道损伤。最初诊断错误,该损伤在术后第四天才被发现。患者接受了Roux-en-Y肝空肠吻合术,随后出现术后胆瘘,通过经皮引流进行处理。后来放置了可生物降解胆道支架以解决狭窄问题,并尽量减少未来干预的必要性。一年后,患者出现胆管炎症状,影像学检查发现胆管腔狭窄。狭窄得到解决,并放置了内镜下胃空肠分流术以预防进一步并发症。患者目前状况良好,无进一步并发症迹象。
本病例强调了早期诊断在处理胆道损伤中的重要性,并突出了可生物降解支架减少重复干预需求的潜力。尽管延迟诊断需要进行复杂的外科手术,但使用可生物降解支架在处理术后并发症方面被证明是有效的。需要进一步研究来评估可生物降解支架在类似临床情况下的长期疗效。