AI Summary & Key Takeaways
AI InsightIn conclusion, ERCP is a safe and effective method for diagnose and treatment in patients with bile duct injury and should be considered always before surgery or percutaneous procedure.
📌 3 Key Takeaways
Abstract
Injury to the bile duct is a serious complication of cholecystectomy and bile tract surgery. The manage ment of these cases is conventionally open laparato my with direct repair. In this study we evaluate the diagnostic and therapeutic ERCP findings with bile duct injury after cholecystectomy in our patients. 28 patients (25 women, 3 men, mean age 43.7) with suspicion of bile duct injury were referred to our clinic for ERCP. Bile ducts of the patients were visualized and found the localization of the injury by ERCP except one (%96.4). Cholangiogram was normal in 1 patient. 8 bile duct transections, 3 severe strictures located in choledochus or bifurcation, 3 bile leaks from choledochus were acutely recognized and treated with surgery. 3 patients with fistula of choledochus or cystic duct stump were treated with sphincterotomy(ST) and nasobiliary drainage (NBD). 5 patients with bile duct stricture, bile leak+stricture, bile duct obstruction+leak, choledocholithiasis+stricture or choledocholithiasis were treated with ST, NBD and removal of the stone with ERCP. Stent was endoscopically applied for a long period in 3 patients. In all, 11(%42.3) of 26 patients with pathological findings were treated by only ERCP procedures. Complications after ERCP were minimal, consisting of three cases of mild, self-limited pancreatitis (% 11.1). In conclusion, ERCP is a safe and effective method for diagnose and treatment in patients with bile duct injury and should be considered always before surgery or percutaneous procedure.
Özet
Safra yolu yaralanması şüphesiyle 25'i kadın, 3'ü erkek olmak üzere 28 hasta (yaş ortalaması 43.7), ERCP işlemi için kliniğimize sevkedildi. Hastaların biri hariç hepsinde (% 96.4) safra yolları ve yaralanmanın lokalizasyonu ERCP ile görüntülendi. 1 hastada safra yollarının görünümü normaldi. Koledokta tam obstrüksiyon saptanan 8, koledok ya da bifürkasyonda ciddi striktür tespit edilen 3, koledoktan kontrast kaçağı olan 3 hastaya cerrahi tamir işlemi uygulandı. Koledok ya da sistik kanaldan kaçak tespit edilen 3 hasta, sfinkterotomi (ST) ve nazobiliyer drenaj (NBD) ile tedavi edildi. Koledokta striktür, fistül, striktür + fistül, obstrüksiyon+ fistül, taş ve striktür+ taş saptanan toplam 5 hastada ST, NBD, taş extrasyonu işlemleri uygulandı. Biri tamir operasyonundan sonra olmak üzere üç hastaya uzun süreli stent uygulandı. Toplam olarak, patolojik bulgusu olan 26 hastanın 10'u (%38.5), yalnızca ERCP girişimleriyle tedavi edildi. ERCP uygulaması sonrası 3 hastada hafif seyirli akut pankreatit görüldü (%11.1). Sonuç olarak; ERCP, safra yolu yaralanmalarının tanı ve tedavisinde emin ve etkili bir yöntem olup, cerrahi veya perkutan girişim öncesi mutlaka düşünülmelidir.