Background and Aim: After successful medical management of a patient with a clinical picture suggestive of post-sphincterotomy duodenal perforation, in which a computerized axial tomography (CAT) scan of the abdomen r...Background and Aim: After successful medical management of a patient with a clinical picture suggestive of post-sphincterotomy duodenal perforation, in which a computerized axial tomography (CAT) scan of the abdomen revealed the presence of subcutaneous emphysema and retroperitoneal air, concern arose as to the frequency of pneumoretroperitoneum following endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy (ES) and if any procedure dependent factors were associated with this problem. Aim: To assess the frequency and clinical significance of retroperitoneal air after endoscopic retrograde cholangiopancreatography with sphincterotomy. Methods: Fifty consecutive patients, who had undergone ERCP with sphincterotomy, were submitted to abdominal CT examinations within 24 hours after completion of the procedure. One patient was with a large precut, but a failed ERCP was also included. The ERCP findings were unknown to the radiologist. Results: Seven (14%) of 50 patients showed CT findings of retroperitoneal air. All of them had uneventful post-procedural recovery. No clinical or laboratory abnormality was found in this group of patients. The presence of retroperitoneal air was not associated to the variables: precut, biliopancreatic disease type, endoscopic sphincterotomy length, additional endoscopic procedure (balloon exploration, gallstone extraction, stent insertion) or procedure duration. Conclusion: After ERCP with ES, retroperitoneal air is frequently found. In the absence of physical symptoms, retroperitoneal air is not clinically relevant and does not require specific treatment.展开更多
BACKGROUND Pseudoaneurysms of the hepatic artery or its branches have been reported following abdominal trauma,iatrogenic injury at the time of many operations such as percutaneous transhepatic biliary drainage and ch...BACKGROUND Pseudoaneurysms of the hepatic artery or its branches have been reported following abdominal trauma,iatrogenic injury at the time of many operations such as percutaneous transhepatic biliary drainage and cholecystectomy.Hepatic artery pseudoaneurysms after endoscopic retrograde cholangiopancreatography(ERCP)are uncommon and potentially life threatening and should be identified and treated rapidly.CASE SUMMARY We report a case of intra-abdominal hemorrhage secondary to a left hepatic artery pseudoaneurysm resulting from guide wire injury at ERCP.The patient primary diagnosis was acute biliary pancreatitis with cholangitis,he underwent ERCP on the third day of admission.During ERCP,the left intrahepatic bile duct was cannulated three times.Over the sixth day,Contrast enhanced computed tomography scan demonstrated left hepatic lobe contusion and a pseudoaneurysm formation.The patient was successfully treated with the embolization of a small branch of left hepatic artery angiographically.CONCLUSION The common complications of ERCP are pancreatitis,bleeding and perforation.False aneurysms occur as a result of damage to the wall of an artery.As far as we know,it is rare complication has been reported following ERCP.We advise urgent referral for angiographic embolization in this situation to avoid aneurysm rupture.展开更多
文摘Background and Aim: After successful medical management of a patient with a clinical picture suggestive of post-sphincterotomy duodenal perforation, in which a computerized axial tomography (CAT) scan of the abdomen revealed the presence of subcutaneous emphysema and retroperitoneal air, concern arose as to the frequency of pneumoretroperitoneum following endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy (ES) and if any procedure dependent factors were associated with this problem. Aim: To assess the frequency and clinical significance of retroperitoneal air after endoscopic retrograde cholangiopancreatography with sphincterotomy. Methods: Fifty consecutive patients, who had undergone ERCP with sphincterotomy, were submitted to abdominal CT examinations within 24 hours after completion of the procedure. One patient was with a large precut, but a failed ERCP was also included. The ERCP findings were unknown to the radiologist. Results: Seven (14%) of 50 patients showed CT findings of retroperitoneal air. All of them had uneventful post-procedural recovery. No clinical or laboratory abnormality was found in this group of patients. The presence of retroperitoneal air was not associated to the variables: precut, biliopancreatic disease type, endoscopic sphincterotomy length, additional endoscopic procedure (balloon exploration, gallstone extraction, stent insertion) or procedure duration. Conclusion: After ERCP with ES, retroperitoneal air is frequently found. In the absence of physical symptoms, retroperitoneal air is not clinically relevant and does not require specific treatment.
基金Supported by the Medical Health Science and Technology Project of Zhejiang Provincial Health Commission,No.2020KY1082and No.2021KY1238。
文摘BACKGROUND Pseudoaneurysms of the hepatic artery or its branches have been reported following abdominal trauma,iatrogenic injury at the time of many operations such as percutaneous transhepatic biliary drainage and cholecystectomy.Hepatic artery pseudoaneurysms after endoscopic retrograde cholangiopancreatography(ERCP)are uncommon and potentially life threatening and should be identified and treated rapidly.CASE SUMMARY We report a case of intra-abdominal hemorrhage secondary to a left hepatic artery pseudoaneurysm resulting from guide wire injury at ERCP.The patient primary diagnosis was acute biliary pancreatitis with cholangitis,he underwent ERCP on the third day of admission.During ERCP,the left intrahepatic bile duct was cannulated three times.Over the sixth day,Contrast enhanced computed tomography scan demonstrated left hepatic lobe contusion and a pseudoaneurysm formation.The patient was successfully treated with the embolization of a small branch of left hepatic artery angiographically.CONCLUSION The common complications of ERCP are pancreatitis,bleeding and perforation.False aneurysms occur as a result of damage to the wall of an artery.As far as we know,it is rare complication has been reported following ERCP.We advise urgent referral for angiographic embolization in this situation to avoid aneurysm rupture.
