Retroperitoneal duodenal perforation as a result of endoscopic biliary sphincterotomy is a rare complication, but it is associated with a relatively high mortality risk, if left untreated. Recently, several endoscopic...Retroperitoneal duodenal perforation as a result of endoscopic biliary sphincterotomy is a rare complication, but it is associated with a relatively high mortality risk, if left untreated. Recently, several endoscopic techniques have been described to close a variety of perforations. In this case report, we describe the closure of a persistent sphincterotomy-related duodenal perforation by using a covered self-expandable metallic biliary (CEMB) stent. A 61-year-old Greek woman underwent an endoscopic retrograde cholangiopancreatography (ERCP) and sphincterotomy for suspected choledo-cholithiasis, and a retroperitoneal duodenal perforation (sphincterotomy-related) occurred. Despite initial conservative management, the patient underwent a laparotomy and drainage of the retroperitoneal space. After that, a high volume duodenal fistula developed. Six weeks after the initial ERCP, the patient underwent a repeat endoscopy and placement of a CEMB stent with an indwelling nasobiliary drain. The fistula healed completely and the stent was removed two weeks later. We suggest the transient use of CEMB stents for the closure of sphincterotomy-related duodenal perforations. They can be placed either during the initial ERCP or even later if there is radiographic or clinical evidence that the leakage persists.展开更多
The aim of this manuscript is to review controversies in managing severe pancreatic fistula after pancreatic surgery.Significant progress in surgical technique and perioperative care has reduced the mortality rate of ...The aim of this manuscript is to review controversies in managing severe pancreatic fistula after pancreatic surgery.Significant progress in surgical technique and perioperative care has reduced the mortality rate of pancreatic surgery.However,leakage of the pancreatic stump still accounts for the majority of surgical complications after pancreatic resection.Various strategies have been employed in order to manage pancreatic fistula.Nonetheless high grade pancreatic fistula evokes controversy in relation to the choice of treatment.A Medline search was performed,with regard to conservative treatment options versus completion pancreatectomy for the management of pancreatic fistula grade C.Pancreatic fistula rates remain unchanged with an incidence ranging from 5%-20% and this is considered as the most important cause of postoperative death.Many authors claim that completion pancreatectomy has probably lost its role in favour of interventional radiology procedures,while others believe that completion pancreatectomy continues to have a place in the management of patients with severe clinical deterioration after pancreatic fistula who do not respond to non-surgical interventions.There is no agreement on the best clinical management of severe pancreatic fistula after pancreatic surgery.Completion pancreatectomy is reserved for patients not improving with conventional measures.展开更多
文摘Retroperitoneal duodenal perforation as a result of endoscopic biliary sphincterotomy is a rare complication, but it is associated with a relatively high mortality risk, if left untreated. Recently, several endoscopic techniques have been described to close a variety of perforations. In this case report, we describe the closure of a persistent sphincterotomy-related duodenal perforation by using a covered self-expandable metallic biliary (CEMB) stent. A 61-year-old Greek woman underwent an endoscopic retrograde cholangiopancreatography (ERCP) and sphincterotomy for suspected choledo-cholithiasis, and a retroperitoneal duodenal perforation (sphincterotomy-related) occurred. Despite initial conservative management, the patient underwent a laparotomy and drainage of the retroperitoneal space. After that, a high volume duodenal fistula developed. Six weeks after the initial ERCP, the patient underwent a repeat endoscopy and placement of a CEMB stent with an indwelling nasobiliary drain. The fistula healed completely and the stent was removed two weeks later. We suggest the transient use of CEMB stents for the closure of sphincterotomy-related duodenal perforations. They can be placed either during the initial ERCP or even later if there is radiographic or clinical evidence that the leakage persists.
文摘The aim of this manuscript is to review controversies in managing severe pancreatic fistula after pancreatic surgery.Significant progress in surgical technique and perioperative care has reduced the mortality rate of pancreatic surgery.However,leakage of the pancreatic stump still accounts for the majority of surgical complications after pancreatic resection.Various strategies have been employed in order to manage pancreatic fistula.Nonetheless high grade pancreatic fistula evokes controversy in relation to the choice of treatment.A Medline search was performed,with regard to conservative treatment options versus completion pancreatectomy for the management of pancreatic fistula grade C.Pancreatic fistula rates remain unchanged with an incidence ranging from 5%-20% and this is considered as the most important cause of postoperative death.Many authors claim that completion pancreatectomy has probably lost its role in favour of interventional radiology procedures,while others believe that completion pancreatectomy continues to have a place in the management of patients with severe clinical deterioration after pancreatic fistula who do not respond to non-surgical interventions.There is no agreement on the best clinical management of severe pancreatic fistula after pancreatic surgery.Completion pancreatectomy is reserved for patients not improving with conventional measures.
