Meyer C, Jobard D, Thiry L, De Manzini N, Rohr S
Service de Chirurgie Générale et Digestive, C.H.U. de Strasbourg-Hautepierre.
J Chir (Paris). 1995 Mar;132(3):118-22.
Among the complications of endoscopic sphincterotomy whose rate is about 10% of cases, the retroduodenal papillary perforation represents about 1% of cases. The diagnosis lies on radiological examination which may show during the sphincterotomy the extravasation of the contrast fluid used for the retrograde cholangiography; it can be suggested by the presence of clinical signs of retroperitoneal sepsis or peritonitis. The treatment depends on the severity or peritonitis. The treatment depends on the severity of the clinical symptomatology; it is generally a medical treatment associating nasogastric aspiration and antibiotherapy, and more rarely a surgical one. There is no consensus concerning surgical modalities. We report 3 cases of retroduodenal papillary perforation treated surgical by a duodenal exclusion aiming to transform a complex fistula in a bilio-pancreatic fistula which can be more easily managed by somatostatine-like drugs.
在内镜下括约肌切开术的并发症中，其发生率约为病例的10%，十二指肠后乳头穿孔约占病例的1%。诊断依靠放射学检查，在括约肌切开术期间可能显示用于逆行胆管造影的造影剂外渗；腹膜后脓毒症或腹膜炎的临床体征也可提示该病。治疗取决于临床症状的严重程度；通常采用鼻胃吸引和抗生素治疗的内科治疗，很少采用外科治疗。关于手术方式尚无共识。我们报告3例十二指肠后乳头穿孔病例，通过十二指肠旷置术进行手术治疗，目的是将复杂瘘转化为胆胰瘘，后者可用生长抑素类似物药物更易于处理。
