ABSTRACT
Objectives: Duodenal perforation as a complication of endoscopic ultrasound-guided fine needle aspiration may progress to acute peritonitis and septic shock. Open surgery, the standard treatment, can be avoided by performing closure during endoscopy using endoscopic clips.Patient: A 77-year-old woman was referred to our hospital with salivary gland swelling. She had elevated hepatobiliary enzymes and jaundice. Computed tomography (CT) revealed pancreatic head swelling and bile duct dilation. Endoscopic ultrasonography revealed a hypoechoic mass in the pancreatic head. The pancreatic head mass was punctured twice using a 22-gauge Franchine-type puncture needle at the duodenal bulb. The endoscope was advanced to the descending part of the duodenum, and part of the superior duodenal angle was perforated (diameter approximately 15 mm) with the endoscope. The duodenal mucosa around the perforation was immediately closed using endoscopic clips.Results: Abdominal CT showed gas in the peritoneal and retroperitoneal spaces. The patient experienced abdominal pain and fever and was treated with fasting and antibiotics. The gas gradually decreased, symptoms improved, and she was discharged 18 days after the perforation. Histopathologically, the pancreatic tissue was consistent as autoimmune pancreatitis.Conclusion: Endoscopic closure using endoscopic clips may be a better therapeutic option for duodenal perforation caused by endoscopy.
ABSTRACT
<b>Objective: </b>Pharmacist interventions are effective for appropriate medical management. The Japanese Society of Hospital Pharmacists has recommended the “pre-avoid report” to foster appropriate pharmacotherapy since 1999. The “pre-avoid report” format consists of two forms : “serious report” and “preventive report.” The number of “preventive reports” has comprised about 90% of “pre-avoid reports.” However, this format of the “preventive report” since 1999 has shown inadequacy due to changes in pharmacists’ ability. In the present study, we conducted a re-modification of the “preventive report” format using an assay to create the present “preventive report” format.<br><b>Methods: </b>We retrospectively reviewed the pharmacists’ “preventive report” of the “pre-avoid report” from January 2014 to December 2014 in the Department of Pharmacy, Okayama University Hospital.<br><b>Results: </b>The present format included 101 cases of “others” in the “preventive report” format. This “others” section consisted of “non-intervention of pharmacotherapy” (51%), “forget to stop pre-operation drugs” (14.7%), and “inadequate treatment (wrong administration day, unnecessary treatment). These factors were not identified with the present format of the “preventive report.”<br><b>Conclusion: </b>In the present study, we suggested that it is necessary to revise the format of the “preventive report” to reflect.