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.	吴阶平, 裘法祖. 黄家驷外科学. 北京: 人民卫生出版社, 2002: 960-962.
4.	Şimşek O, Şimşek 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, 吴卫泽, 王建承, 等. ERCP 相关十二指肠穿孔诊治的经验和教训. 外科理论与实践, 2007, 12(6): 562-565.
7.	李兆申. 中国 ERCP 研究现状. 中国消化内镜, 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.	董家鸿. 胆胰肠结合部外科-一个值得重视和研究的领域. 中国实用外科杂志, 2010, 30(5): 332-333.
10.	曾斌, 姚育红, 廖爱军, 等. 诊治性内镜下逆行胰胆管造影操作技巧及并发症分析. 中国内镜杂志, 2007, 13(4): 413-415.
11.	Bostancı Ö, Battal M, Yazıcı 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, 韩大正. 内镜诊治十二指肠乳头旁憩室 256 例分析. 中国内镜杂志, 2017, 20(3): 310-312.
13.	孟翔凌, 张宗耀. 胆总管下段解剖与外科临床. 普外基础与临床杂志, 1997, 12(4): 228-229.
14.	汤朝晖, 黑振宇, 翁明哲, 等. 胆总管下段解剖生理特点与损伤分型的关系. 中国实用外科杂志, 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.	施维锦. 胆胰结合部医源性损伤. 中国实用外科杂志, 2010, 30(5): 363-365.
18.	李可为, 张希文, 丁俊, 等. ERCP 致胆胰肠结合部损伤 2 例报告并国内文献分析. 中国普通外科杂志, 2010, 19(2): 198-202.
19.	王坚, 吴志勇, 施维锦. 医源性胆胰肠结合部损伤的诊断与处理. 外科理论与实践, 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, 潘华洋. 胆胰肠结合部医源性损伤及防治策略. 中国实用外科杂志, 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. 吴阶平, 裘法祖. 黄家驷外科学. 北京: 人民卫生出版社, 2002: 960-962.
4. Şimşek O, Şimşek 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, 吴卫泽, 王建承, 等. ERCP 相关十二指肠穿孔诊治的经验和教训. 外科理论与实践, 2007, 12(6): 562-565.
7. 李兆申. 中国 ERCP 研究现状. 中国消化内镜, 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. 董家鸿. 胆胰肠结合部外科-一个值得重视和研究的领域. 中国实用外科杂志, 2010, 30(5): 332-333.
10. 曾斌, 姚育红, 廖爱军, 等. 诊治性内镜下逆行胰胆管造影操作技巧及并发症分析. 中国内镜杂志, 2007, 13(4): 413-415.
11. Bostancı Ö, Battal M, Yazıcı 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, 韩大正. 内镜诊治十二指肠乳头旁憩室 256 例分析. 中国内镜杂志, 2017, 20(3): 310-312.
13. 孟翔凌, 张宗耀. 胆总管下段解剖与外科临床. 普外基础与临床杂志, 1997, 12(4): 228-229.
14. 汤朝晖, 黑振宇, 翁明哲, 等. 胆总管下段解剖生理特点与损伤分型的关系. 中国实用外科杂志, 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. 施维锦. 胆胰结合部医源性损伤. 中国实用外科杂志, 2010, 30(5): 363-365.
18. 李可为, 张希文, 丁俊, 等. ERCP 致胆胰肠结合部损伤 2 例报告并国内文献分析. 中国普通外科杂志, 2010, 19(2): 198-202.
19. 王坚, 吴志勇, 施维锦. 医源性胆胰肠结合部损伤的诊断与处理. 外科理论与实践, 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, 潘华洋. 胆胰肠结合部医源性损伤及防治策略. 中国实用外科杂志, 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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