Schmassmann A
Departement Innere Medizin, Inselspital, Universität Bern.
Ther Umsch. 1998 Sep;55(9):589-91.
A 73-year-old man was admitted to the hospital because of recurrent fever and intermittent cholestasis. A cholecystectomy with hepatico-duodenostomy was performed ten years ago because of acute cholecystitis and impacted bile duct stones. Recurrent episodes of cholangitis occurred postoperatively and ERCP showed shrinkage of the hepatico-duodenal anastomosis with sump syndrome and recurrent bile duct stones. Endoscopic sphincterotomy for the improvement of bile flow was considered too dangerous at this time-point because of unfavourable intraduodenal position of the papilla Vateri. The patient refused reoperation. During the present hospitalization, endoscopic sphincterotomy and gallstone removal were performed. Within hours after intervention, necrotizing pancreatitis developed which could be managed without operation. No further episodes of cholangitis reoccurred after discharge from hospital. This case report demonstrates the risks of bile duct surgery and endoscopic sphincterotomy.
一名73岁男性因反复发热和间歇性胆汁淤积入院。十年前，因急性胆囊炎和胆管结石嵌顿行胆囊切除术及肝十二指肠吻合术。术后胆管炎反复发作，内镜逆行胰胆管造影（ERCP）显示肝十二指肠吻合口狭窄伴残端综合征及复发性胆管结石。由于 Vater 乳头在十二指肠内位置不佳，此时行内镜括约肌切开术以改善胆汁流动被认为过于危险。患者拒绝再次手术。在本次住院期间，进行了内镜括约肌切开术和胆结石取出术。干预后数小时内发生坏死性胰腺炎，经非手术治疗。出院后未再发生胆管炎发作。本病例报告展示了胆管手术和内镜括约肌切开术的风险。
