RESUMEN
The anatomy and position of choledocho-pancreatico-duodenal junction are unique,so choledocho-pancreatico-duodenal junction is easily be injured during operation,and thus it needs further investigation.Anatomical,pathological and iatrogenic factors are the 3 main causes of choledocho-pancreatico-duodenal junction injury.The diagnosis of choledocho-pancreatico-duodenal junction injury includes intraoperative and postoperative diagnosis; and the treatment methods include intraoperative repaire and suture,T tube drainage,postoperative debridement and drainage,biliopancreatic shunt,duodenal diverticulum,jejunum stoma,gastrointestinal and biliary reconstruction.Precise operation,T tube cholangiography,choledochoscopy can effectively prevent the choledocho-pancreatico-duodenal junction injury.The principle of early discovery,early management,avoiding over-management,and promoting damage control surgery should be awared to reduce the mortality.
RESUMEN
The choledocho-pancreatico-duodenal junc-tion is located at the central part of choledocho-pancreatico-duodenal region. During early embryogenetic stage, the primary duodenum develops from the end of foregut and the beginning part of the midgut. The dorsal pancreas, hepatic diverticulum and the ventral pancreas which arises from the basic part of hepatic diverticulum are growing and rotating following the duodenum. During the course, the formations of the choledocho-pancreatico-duodenal region and the central part of choledocho-pancreatico-duodenal junction are complete. The injuries in cho-ledocho-pancreatico-duedenal junction may be caused by metal probe or lithotomy forceps for exploring, dilatating the distal bile duct or taking out the stones from the bile duct. Even if the injuries of choledocho-pancreatico-duodenal junction are deve-loped in a limited scope of several centimeters, several adjacent organs may be involved. Injuries in choledocho-pancreatico-duo-denal junction are hard to be identified during operation and may develop into serious pathological procedures.
RESUMEN
Iatrogenic injury in choledocho-pancreatico-duodenal junction is usually difficult to discover in the course of operation because of its unique anatomical position. The injury can lead to postoperative chilis, fever, pain and swelling of the waist, which would easily be misdiagnosed as acute necrotizing pancreatitis. Controlling operations, such as bile and pancreatic juice separation, duodenal diverticularization, jejunal fistulation for enteral nutrition and abdominal drainage should be performed in dealing with the injury in choledocho-pancreatico-duodenal junction. Combined application of pyloric suture with absorbable thread and ligatian, gastric fistulation, ligation of the distal common bile duct and T-tube drainage is minimally invasive, and can fulfill a fully separation of bile and pancreatic juice and duodenal diverticularization. It will improve the possibility of secondary radical operation by ameliorating pyemia and general nutritional condition.
RESUMEN
Objective To investigate the diagnosis and treatment of injury in choledocho-pancreatico-duodenal junction. Methods The clinical data of 6 patients with injury in choledocho-pancreatico-duodenal junction who had been admitted to Beijing Hospital from January 2000 to January 2008 were retrospectively analyzed. Results Of the 6 patients, 4 were diagnosed according to the intraoperative findings, cholangiography and fiber cholangioscopy. The 4 patients were cured after suture of the perforation in the choledocho-pancreatico-duodenal junction, T-tube drainage and abdominal drainage. Two patients developed severe abdominal and retroperitoneal infection and other complications after operation, and were diagnosed by cholangiography and fiber cholangioscopy. Of the 2 patients, 1 was cured and 1 died after multiple drainage procedures and debridement. Conclusions Diagnosis and treatment in the early stage are crucial for the curative purpose. Cholangingraphy and fiber cholangioscopy are effective in the diagnosis of injury in choledocho-pancreatico-duodenal junction. The suture of the perforation in the choledocho-pancreatico-duodenal junction, T-tube drainage and abdominal drainage should be chosen for patients who are diagnosed during primary operation. For patients with abdominal and retroperitoneal abscess and cellulitis, drainage and debridement should be performed, and biliopancreatic diversion and duodenal diverticularizatian are applied to patients when necessary.
RESUMEN
Objective To summarize the experience in prevention and management of delayed-diagnosed injury in choledocho-pancreatico-duodenal junction. Methods The clinical data of 5 patients with injury in chole-docho-pancreatico-duodenal junction who had received surgery from 2000 to 2007 in Peking Union Hospital was summarized and analyzed retrospectively. All the 5 patients were diagnosed 24 hours after the injury. The injury was caused after endoscopic retrograde cholangiopancreatography (or endoscopic sphincterotomy) +endovascular stent placement in 4 patients and by vehicle accident in 1 patient. Results All the patients were treated conserva-tively for 24-72 hours, and peritonitis was not alleviated, and were subsequently transferred to surgery. Three patients received gastrostomy +choledochostomy +jejunostomy. The abdominal pain was alleviated in 1 patient, and 2 died of multiple organ dysfunction syndrome 5-6 weeks later. Two patients received duodenal diverticulariza-tion + gastrostomy + jejunostomy + Roux-en-Y choledachojejunostomy + Roux-en-Y gastrojejunostomy, and had good prognosis. Conclusion Duodenal diverticularization is a proper choice for patients with perforation combined with severe intraabdominal infection.
RESUMEN
Because of the particularity in causes, mecha-nisms and clinical performances, injury in choledocho-pancreatico-duodenal junction is usually doomed with a delayed diagnosis, often leading to a poor prognosis. The early manifestations of bile duct perforation include peritoneal swelling caused by detained water after trans-T-tube injection, blue staining of the field of operation and contrast medium leaking outside the bile duct system, peritoneal or abdominal gas accumulation, pneu-mothorax or subcutaneous emphysema after endoscopic sphincte-rotomy (EST) or endoscopic retrograde cholangiopancreatogra-phy (ERCP). Postoperative high fever, abdomical pain radia-ting to right side back and waist, fluid accumulation in the right iliac fossa or around the right kidney are the associated evidences. If the perforation is discovered during the operation, it should be sutured and choledocal T-tube drainage should be performed. If the perforation is not discovered during the opera-tion, biliointestinal bypass should be constructed. The injuries resulted from ERCP or EST procedures should be treated accord-ing to the detailed situation. Conservative treatment can be given to those who are in relatively stable status. If the condition of the patients deteriorated, timely conversion to laparotomy is needed. For patients with delayed diagnosis, thorough drainage of the region, separation of bile and pancreatic juice, duodenal diver-ticularization and jejunostomy should be considered. The key point in preventing the injury in choledocho-pancreatico-duode-hal junction lies on full knowledge of the anatomy of the region, delicate practice without forceful exploration and detailed exami-nation after the operation to avoid missing diagnosis.
RESUMEN
Injuries in the choledocho-pancreatico-duo-denal junction are rare, and are frequently associated with other severe vascular and visceral injuries. Interventions during early operation may aggravate the condition of patients, while proper application of damage control surgery (DCS) is helpful in raising the survival rate. Therefore, for most of the patients with choledocho-pancereatico-duodenal junction injury, definite opera-tion should be performed after removal of necrotic tissues, control of infection and adequate drainage. However, DCS should be applied with caution, and the indications of DCS should be strictly followed, because reoperation will increase the chance of injury and infection after DCS.
RESUMEN
The causes of iatrogenic injury in choledo-cho-pancreatico-duodenai junction include iatrogenic factors, anatomic factors and pathological factors. T-tube, methylthionine chloride and fiber choledochoscopy are useful methods for early diagnosis. Accurate exploration of the injury site and reasonable choice of management were significant in dealing with the iatrogenie injury and can lead to a satisfactory result. Choledo-chojejunostomy and Oddi sphincteroplasty are not recommended unless the patients had distal bile duet stricture or the stones can not be removed. Accurate detection of the injury site, evaluation of the severity, and proper choice of the surgical method are important for the prognosis of the patients.
RESUMEN
Injury of choledocho-pancreatico-duodenal junction refers to the penetrating injury of the bile duct, pancrea-tic duct or duodenal wall in the region of ampulla of Vater. It is often caused by improper operation of surgical instruments, and may lead to leakage of bile, pancreatic or duodenal contents into retroperitoneal space and chemical corrosion in a wide range of retroperitoneal soft tissue, which result in severe secondary infection or even death. Leakage of contrast media, hypertrophy of tissue and anatomical changes were the evidences for injury of choledocho-pancreatico-duodenal junction. Injury of choledocho-pancreatico-duodenal junction can be. divided into 4 types, and treatment selected according to different types of injury is neces-sary for the prognosis of patients.