Case Report The Korean Journal of Pancreas and Biliary Tract 2015;20:146-150 http://dx.doi.org/10.15279/kpba.2015.20.3.146 pissn 1976-3573 eissn 2288-0941 경구담도내시경후발생한간내담도천공의증 1 예 광주기독병원소화기내과 박대원 박상욱 김두진 유경완 이금수 김종택 서석호 이승현 A Case of Suspected Intrahepatic Bile Duct Perforation after Direct Peroral Cholangioscopy Dae Won Park, Sang Wook Park, Du Jin Kim, Kyoung Wan You, Geum Soo Lee, Jong Taek Kim, Seok Ho Seo, Seung Hyun Lee Divison of Gastroenterology, Department of Internal Medicine, GwangJu Christian Hospital, Gwangju, Korea Direct peroral cholangioscopy (POC) which permits direct visualization of the biliary tree has recently gained widespread clinical use for diagnosis and treatment of various pancreatobiliary diseases. But, there is currently little reliable data on evaluating the complications of POC. POC is associated with complications such as pancreatitis, cholangitis, hemorrhage, rarely air embolism, and ductal perforation. The incidence of complication during POC is 2.9-12%. However, pneumoperitoneum due to intrahepatic bile duct perforation after POC has not yet been reported in Korea. We report a case of pneumoperitoneum after POC which has been successfully managed with endoscopic nasobiliary drainage and antibiotics. Keywords: Peroral cholangioscopy, Pneumoperitoneum, Bile duct perforation, Common bile duct stone, Electrohydraulic lithotripsy Received Feb. 27, 2015 Revised May. 20, 2015 Accepted May. 21, 2015 Corresponding author : Sang Wook Park Divison of Gastroenterology, Department of Internal Medicine, Gwangju Christian Hospital, 37, Yangnim-ro, Nam-gu, Gwangju 503-715, Korea Tel. +82-62-650-5023 Fax. +82-62-650-5277 E-mail; kch20113@hanmail.net This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Copyright 2015 by The Korean Journal of Pancreas and Biliary Tract 서론 (peroral cholangioscopy, POC). (motherbaby duodenoscope) POC, (ultra-slim upper endoscope). direct POC... POC, 146 Copyright 2015 by Korean Pancreatobiliary Association
Dae Won Park, et al.. 1,2 POC (electrohydraulic lithotripsy, EHL) 1. 증례 89 10. 15. 36.7, 64, 18, 140/80 mmhg... 4,400/mm³, 10.8 g/dl, 232,000/mm³. 131 IU/L, 210 IU/L, 669 IU/L, 672 IU/L, 1.3 mg/dl, 77 IU/L, 45.7 IU/L. (computed tomography, CT) (Fig. 1A). (percutaneous transhepatic gallbladder biliary drainage, PTGBD). (endoscopic retrogradecholangiopancreatography, ERCP) 18 mm 15 mm (Fig. 1B). (endoscopic papillary large balloon dilation, EPLBD). POC. EHL (Fig. 2). EHL. A B Fig. 1. (A) Abdominal computed tomography shows multiple common bile duct stones (white arrow), common bile duct and intrahepatic bile duct dilation, and marked gall bladder distension. (B) Endoscopic retrograde cholangiogram shows dilation of the common bile duct with large filling defect (black arrow). 147
Suspected Intrahepatic Bile Duct Perforation after Direct Peroral Cholangioscopy 1 X- (Fig. 3A). CT, (Fig. 3B, C). ERCP (endoscopic nasobiliary drainage, ENBD). 3 CT ERCP. 고찰 1970 (percutaneous transhepatic cholangioscopy, PTCS) POC. 3,4 (mother-baby endoscopy system) (mother scope) (baby scope). A B C Fig. 2. (A) Direct peroral cholangioscopy shows a impacted stone inside the common bile duct. (B) After electrohydraulic lithotripsy, impacted stone is fragmented and removed with a basket. (C) Fluoroscopy shows the ultraslim upper endoscope in the distal common bile duct with the impacted emergent lithotriptor. A B C Fig. 3. (A) Chest X -ray finding after endoscopic retrograde cholangiography and direct peroral cholangioscopy. Free air is noted in the subdiaphragmic area. (B) Abdominal computed tomography taken on the day after endoscopy shows pneumobilia and perihepatic free air (white arrow). (C) No free air is seen in retroperitoneum around duodenum and common bile duct. 148 http://dx.doi.org/10.15279/kpba.2015.20.3.146
Dae Won Park, et al.,. 5 SpyGlass. 5-6 mm, 2.0 mm. 6. 5,7-9. Meves 2 100 POC 87% 81%. 12% 7, 1, 2. POC,. 10,11,., Parsi 12.. 13,. EHL. 1% 14. 15..,., 50 cc EHL.. POC. 149
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