Attach importance to the prevention and treatment of iatrogenic injury in choledocho-pancreatico-duodenal junction / 中华消化外科杂志

ABSTRACT

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.