Analysis of diagnosis and treatment for 11 patients with perforation of choledocho- pancreatico-duodenal junction associated with endoscopic retrograde cholangiopancreatography_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHU Yongqiang ,  WANG Tao , CHENG Long , TAN Zhen , YU Qianjun

Department of General Surgery, Chengdu Military General Hospital, Chengdu 610083, P. R. China;

Corresponding?author：

WANG Tao, Email: watopo@163.com

Keywords：

endoscopic retrograde cholangiopancreatography; choledocho-pancreatico-duodenal junction; perforation; treatment

DOI：

10.7507/1007-9424.201805095

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Objective To analyze cause and therapy of perforation of choledocho-pancreatico-duodenal junction associated with endoscopic retrograde cholangiopancreatography (ERCP) and its related procedures. Method The clinical data of 11 patients diagnosed with the perforation of choledocho-pancreatico-duodenal junction associated with the ERCP from January 2010 to January 2017 were analyzed retrospectively. Results Of 11 patients, 5 were diagnosed within 24 h, 3 were diagnosed between 24 h and 48 h, 3 were diagnosed above 48 h. Seven patients who immediately operated were cured following definitive diagnosis, 2 died after undergoing the delayed operation, 2 died after receiving the conservative treatment. The results of the anatomical-pathological factors showed that 4 were the anomalous arrangement of pancreaticobiliary ducts, 2 were the periampullary diverticula, 3 were the exposure of common bile duct in the pancreas level, 2 had no bile duct abnormality. Conclusions Preoperative evaluation on anatomical-pathological factor of bile duct is importance to effectively predict risk of perforation of choledocho-pancreatico-duodenal junction associated with ERCP. Early precise diagnosis and actively surgical operation are essential for optimal outcome in patient with perforation of choledocho-pancreatico-duodenal junction associated with ERCP.

Citation： ZHU Yongqiang, WANG Tao, CHENG Long, TAN Zhen, YU Qianjun. Analysis of diagnosis and treatment for 11 patients with perforation of choledocho- pancreatico-duodenal junction associated with endoscopic retrograde cholangiopancreatography. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2018, 25(11): 1332-1336. doi: 10.7507/1007-9424.201805095 Copy

1.	Bill JG, Smith Z, Brancheck J, et al. The importance of early recognition in management of ERCP-related perforations. Surg Endosc, 2018 May 16. doi: 10.1007/s00464-018-6235-8.[Epub ahead of print].
2.	Jiménez Cubedo E, López Monclús J, Lucena de la Poza JL, et al. Review of duodenal perforations after endoscopic retrograde cholangiopancreatography in Hospital Puerta de Hierro from 1999 to 2014. Rev Esp Enferm Dig, 2018, 110(8): 515-519.
3.	吳階平, 裘法祖. 黃家駟外科學. 北京: 人民衛生出版社, 2002: 960-962.
4.	?im?ek O, ?im?ek A, Ergun S, et al. Managing endoscopic retrograde cholangiopancreatography-related complications in patients referred to the surgical emergency unit. Ulus Travma Acil Cerrahi Derg, 2017, 23(5): 395-399.
5.	Khan MS, Jamal F, Khan Z, et al. ERCP-related duodenal perforation presenting as pneumoscrotum. Case Rep Gastroenterol, 2018, 12(1): 1-6.
6.	毛志海, 吳衛澤, 王建承, 等. ERCP 相關十二指腸穿孔診治的經驗和教訓. 外科理論與實踐, 2007, 12(6): 562-565.
7.	李兆申. 中國 ERCP 研究現狀. 中國消化內鏡, 2008, 2(9-10): 1-4.
8.	Altonbary AY, Bahgat MH. Endoscopic retrograde cholangiopancreatography in periampullary diverticulum: The challenge of cannulation. World J Gastrointest Endosc, 2016, 8(6): 282-287.
9.	董家鴻. 膽胰腸結合部外科-一個值得重視和研究的領域. 中國實用外科雜志, 2010, 30(5): 332-333.
10.	曾斌, 姚育紅, 廖愛軍, 等. 診治性內鏡下逆行胰膽管造影操作技巧及并發癥分析. 中國內鏡雜志, 2007, 13(4): 413-415.
11.	Bostanc? ?, Battal M, Yaz?c? P, et al. Management of iatrogenic injuries due to endoscopic sphincterotomy: Surgical or conservative approaches. Turk J Surg, 2018, 34(1): 24-27.
12.	丁春生, 韓大正. 內鏡診治十二指腸乳頭旁憩室 256 例分析. 中國內鏡雜志, 2017, 20(3): 310-312.
13.	孟翔凌, 張宗耀. 膽總管下段解剖與外科臨床. 普外基礎與臨床雜志, 1997, 12(4): 228-229.
14.	湯朝暉, 黑振宇, 翁明哲, 等. 膽總管下段解剖生理特點與損傷分型的關系. 中國實用外科雜志, 2013, 33(5): 357-360.
15.	Fatima J, Baron TH, Topazian MD, et al. Pancreaticobiliary and duodenal perforations after periampullary endoscopic procedures: diagnosis and management. Arch Surg, 2007, 142(5): 448-455.
16.	Mateo Retuerta J, Chaveli Díaz C, Goikoetxea Urdiain A, et al. Perforations following endoscopic retrograde cholangiopancreatography (ERCP). An Sist Sanit Navar, 2017, 40(1): 145-151.
17.	施維錦. 膽胰結合部醫源性損傷. 中國實用外科雜志, 2010, 30(5): 363-365.
18.	李可為, 張希文, 丁俊, 等. ERCP 致膽胰腸結合部損傷 2 例報告并國內文獻分析. 中國普通外科雜志, 2010, 19(2): 198-202.
19.	王堅, 吳志勇, 施維錦. 醫源性膽胰腸結合部損傷的診斷與處理. 外科理論與實踐, 2009, 14(2): 147-149.
20.	Motomura Y, Akahoshi K, Gibo J, et al. Immediate detection of endoscopic retrograde cholangiopancreatography-related periampullary perforation: Fluoroscopy or endoscopy? World J Gastroenterol, 2014, 20(42): 15797-15804.
21.	Guerra F, Giuliani G, Coletta D, et al. Clinical outcomes of ERCP-related retroperitoneal perforations. Hepatobiliary Pancreat Dis Int, 2017, 16(2): 160-163.
22.	Kim JH, Yoo BM, Kim JH, et al. Management of ERCP-related perforations: outcomes of single institution in Korea. J Gastrointest Surg, 2009, 13(4): 728-734.
23.	Stapfer M, Selby RR, Stain SC, et al. Management of duodenal perforation after endoscopic retrograde cholangiopancreatography and sphincterotomy. Ann Surg, 2000, 232(2): 191-198.
24.	Preetha M, Chung YF, Chan WH, et al. Surgical management of endoscopic retrograde cholangiopancreatography-related perforations. ANZ J Surg, 2003, 73(12): 1011-1014.
25.	姜洪池, 潘華洋. 膽胰腸結合部醫源性損傷及防治策略. 中國實用外科雜志, 2013, 33(5): 351-353.

1. Bill JG, Smith Z, Brancheck J, et al. The importance of early recognition in management of ERCP-related perforations. Surg Endosc, 2018 May 16. doi: 10.1007/s00464-018-6235-8.[Epub ahead of print].
2. Jiménez Cubedo E, López Monclús J, Lucena de la Poza JL, et al. Review of duodenal perforations after endoscopic retrograde cholangiopancreatography in Hospital Puerta de Hierro from 1999 to 2014. Rev Esp Enferm Dig, 2018, 110(8): 515-519.
3. 吳階平, 裘法祖. 黃家駟外科學. 北京: 人民衛生出版社, 2002: 960-962.
4. ?im?ek O, ?im?ek A, Ergun S, et al. Managing endoscopic retrograde cholangiopancreatography-related complications in patients referred to the surgical emergency unit. Ulus Travma Acil Cerrahi Derg, 2017, 23(5): 395-399.
5. Khan MS, Jamal F, Khan Z, et al. ERCP-related duodenal perforation presenting as pneumoscrotum. Case Rep Gastroenterol, 2018, 12(1): 1-6.
6. 毛志海, 吳衛澤, 王建承, 等. ERCP 相關十二指腸穿孔診治的經驗和教訓. 外科理論與實踐, 2007, 12(6): 562-565.
7. 李兆申. 中國 ERCP 研究現狀. 中國消化內鏡, 2008, 2(9-10): 1-4.
8. Altonbary AY, Bahgat MH. Endoscopic retrograde cholangiopancreatography in periampullary diverticulum: The challenge of cannulation. World J Gastrointest Endosc, 2016, 8(6): 282-287.
9. 董家鴻. 膽胰腸結合部外科-一個值得重視和研究的領域. 中國實用外科雜志, 2010, 30(5): 332-333.
10. 曾斌, 姚育紅, 廖愛軍, 等. 診治性內鏡下逆行胰膽管造影操作技巧及并發癥分析. 中國內鏡雜志, 2007, 13(4): 413-415.
11. Bostanc? ?, Battal M, Yaz?c? P, et al. Management of iatrogenic injuries due to endoscopic sphincterotomy: Surgical or conservative approaches. Turk J Surg, 2018, 34(1): 24-27.
12. 丁春生, 韓大正. 內鏡診治十二指腸乳頭旁憩室 256 例分析. 中國內鏡雜志, 2017, 20(3): 310-312.
13. 孟翔凌, 張宗耀. 膽總管下段解剖與外科臨床. 普外基礎與臨床雜志, 1997, 12(4): 228-229.
14. 湯朝暉, 黑振宇, 翁明哲, 等. 膽總管下段解剖生理特點與損傷分型的關系. 中國實用外科雜志, 2013, 33(5): 357-360.
15. Fatima J, Baron TH, Topazian MD, et al. Pancreaticobiliary and duodenal perforations after periampullary endoscopic procedures: diagnosis and management. Arch Surg, 2007, 142(5): 448-455.
16. Mateo Retuerta J, Chaveli Díaz C, Goikoetxea Urdiain A, et al. Perforations following endoscopic retrograde cholangiopancreatography (ERCP). An Sist Sanit Navar, 2017, 40(1): 145-151.
17. 施維錦. 膽胰結合部醫源性損傷. 中國實用外科雜志, 2010, 30(5): 363-365.
18. 李可為, 張希文, 丁俊, 等. ERCP 致膽胰腸結合部損傷 2 例報告并國內文獻分析. 中國普通外科雜志, 2010, 19(2): 198-202.
19. 王堅, 吳志勇, 施維錦. 醫源性膽胰腸結合部損傷的診斷與處理. 外科理論與實踐, 2009, 14(2): 147-149.
20. Motomura Y, Akahoshi K, Gibo J, et al. Immediate detection of endoscopic retrograde cholangiopancreatography-related periampullary perforation: Fluoroscopy or endoscopy? World J Gastroenterol, 2014, 20(42): 15797-15804.
21. Guerra F, Giuliani G, Coletta D, et al. Clinical outcomes of ERCP-related retroperitoneal perforations. Hepatobiliary Pancreat Dis Int, 2017, 16(2): 160-163.
22. Kim JH, Yoo BM, Kim JH, et al. Management of ERCP-related perforations: outcomes of single institution in Korea. J Gastrointest Surg, 2009, 13(4): 728-734.
23. Stapfer M, Selby RR, Stain SC, et al. Management of duodenal perforation after endoscopic retrograde cholangiopancreatography and sphincterotomy. Ann Surg, 2000, 232(2): 191-198.
24. Preetha M, Chung YF, Chan WH, et al. Surgical management of endoscopic retrograde cholangiopancreatography-related perforations. ANZ J Surg, 2003, 73(12): 1011-1014.
25. 姜洪池, 潘華洋. 膽胰腸結合部醫源性損傷及防治策略. 中國實用外科雜志, 2013, 33(5): 351-353.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Analysis of diagnosis and treatment for 11 patients with perforation of choledocho- pancreatico-duodenal junction associated with endoscopic retrograde cholangiopancreatography

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