Müller M F, Krestin G P, Weder W, Münch R, Wegmann A
Departement Medizinische Radiologie, Universitätsspital Zürich.
Dtsch Med Wochenschr. 1993 Mar 19;118(11):377-80. doi: 10.1055/s-2008-1059339.
A previously well 24-year-old man complained of persistent epigastric pain after a session of intensive muscle building exercise especially of the abdominal muscles. The abdomen was diffusely tender without guarding. There was an increased concentration of bilirubin (64.7 mumol/l), GOT (117 U/l), GPT (529 U/l) and alkaline phosphatase (150 U/l). Ultrasound examination showed a widening of the choledochal duct to 11 mm without signs of gallstones. Endoscopic retrograde cholangiography additionally revealed contrast-medium extravasation from the left hepatic duct. Computed tomography, performed immediately afterwards, confirmed the extravasation, while liver and pancreas were unremarkable. Laparoscopy revealed a 5 mm tear in the left hepatic duct, close to the hepatic duct bifurcation with bile effusion into the peritoneal cavity. The latter was rinsed endoscopically with Ringer's solution and drains were placed in the omental bursa and subhepatically in the region of the bile leak. To relax the sphincter Oddi glycerol trinitrate was administered postoperatively, for the first five days 72 mg/24 h intravenously, then for nine days twice daily 20 mg by month. No more bile drained as early as the second postoperative day and the patient was free of symptoms 2 weeks later.
一名此前健康的24岁男性在进行了一轮高强度肌肉锻炼，尤其是腹部肌肉锻炼后，出现持续性上腹部疼痛。腹部弥漫性压痛，无肌紧张。胆红素（64.7μmol/l）、谷草转氨酶（117U/l）、谷丙转氨酶（529U/l）和碱性磷酸酶（150U/l）浓度升高。超声检查显示胆总管增宽至11mm，无胆结石迹象。内镜逆行胆管造影另外显示有造影剂从左肝管外渗。随后立即进行的计算机断层扫描证实了外渗情况，而肝脏和胰腺无异常。腹腔镜检查发现左肝管有一个5mm的裂口，靠近肝管分叉处，胆汁渗入腹腔。通过内镜用林格氏液冲洗腹腔，并在网膜囊和肝下胆汁漏出区域放置引流管。为松弛Oddi括约肌，术后给予硝酸甘油，最初5天静脉注射72mg/24h，然后9天每天2次，每次20mg口服。术后第二天就不再有胆汁引流，患者在2周后无症状。
