ABSTRACT
Endoscopic biliary drainage through endoscopic retrograde cholangiopancreatography (ERCP) is a widely accepted therapeutic option in malignant biliary obstructions. However, the procedure is not free of complications. Perforation is one possible complication although it is much less frequent (less than 1%) than pancreatitis (5.4%) or hemorrhage (2%). We present 2 cases of duodenal perforation after placement of a biliary prosthesis through ERCP. Both patients had extensive hilar cholangiocarcinoma. Onset of symptoms of perforation occurred a few hours after placement of the prosthesis and the diagnosis was confirmed by computed tomography and laparotomy. We believe that the mechanism through which perforation occurred was proximal adhesion of the prosthesis to the tumor. This increased the intensity of distal trauma produced by the intraduodenal segment, preventing adaptation of the prosthesis to intestinal peristalsis. A good preventive measure would consist of correctly adjusting the length of the prosthesis in relation to the proximal end of the biliary stenosis.
Subject(s)
Bile Duct Neoplasms/surgery , Cholangiocarcinoma/surgery , Cholangiopancreatography, Endoscopic Retrograde/adverse effects , Duodenal Diseases/etiology , Intestinal Perforation/etiology , Stents/adverse effects , Aged , Female , Humans , Middle AgedABSTRACT
El drenaje biliar endoscópico mediante la colangiopancreatografíaretrógrada endoscópica (CPRE) es una alternativaterapéutica aceptada para las obstrucciones biliares malignas,que no está exenta de complicaciones. La perforación esuna de éstas, aunque mucho menos frecuente (menos de 1%)que la pancreatitis (5,4%) o la hemorragia (2%). Presentamos2 casos de perforación duodenal tras la colocación deuna prótesis biliar por CPRE. En ambos casos, se tratabade un colangiocarcinoma hiliar extenso, la clínica relacionadacon la perforación fue de inicio temprano, horas despuésde la colocación de la prótesis, y la tomografía computarizadajunto a la laparotomía confirmaron el diagnóstico de lacomplicación. Creemos que el mecanismo por el cual se produjola perforación fue por fijación proximal de la prótesispor el tumor. Ésta aumentaba la intensidad del trauma distalproducido por el segmento intraduodenal e impedía laadaptación de la prótesis al peristaltismo intestinal. Unabuena medida de prevención sería un adecuado ajuste de lalongitud de la prótesis respecto al extremo proximal de la estenosisbiliar
Endoscopic biliary drainage through endoscopic retrogradecholangiopancreatography (ERCP) is a widely accepted therapeuticoption in malignant biliary obstructions. However,the procedure is not free of complications. Perforation is onepossible complication although it is much less frequent (lessthan 1%) than pancreatitis (5.4%) or hemorrhage (2%). Wepresent 2 cases of duodenal perforation after placement of abiliary prosthesis through ERCP. Both patients had extensive hilar cholangiocarcinoma. Onset of symptoms of perforationoccurred a few hours after placement of the prosthesisand the diagnosis was confirmed by computed tomographyand laparotomy. We believe that the mechanism throughwhich perforation occurred was proximal adhesion of theprosthesis to the tumor. This increased the intensity of distaltrauma produced by the intraduodenal segment, preventingadaptation of the prosthesis to intestinal peristalsis. A goodpreventive measure would consist of correctly adjusting thelength of the prosthesis in relation to the proximal end ofthe biliary stenosis
Subject(s)
Female , Humans , Cholangiocarcinoma/surgery , Cholangiopancreatography, Endoscopic Retrograde/adverse effects , Duodenal Diseases/etiology , Intestinal Perforation/etiology , Stents/adverse effects , Bile Duct Neoplasms/surgeryABSTRACT
OBJECTIVES: to analyse survival and quality of life of patients with malignant obstructive jaundice after palliative treatment, comparing endoscopic stent insertion and palliative surgical (palliative resection and bypass surgical). PATIENTS AND METHOD: eighty and seven patients were included in a trial. They were distributed to endoscopic stent (50) and palliative surgical (37). It analysed survival, quality of life and comfort index of jaundiced patients. The good quality of life was defined by absence of jaundice, pruritus and cholangitis after the initial treatment. RESULTS: the median survival of the patients treated to endoscopic stent was 9,6 months whereas the patients to surgical treatment survived a median of 17 months. The time free of disease was 4 months in stented patients and 10,5 months in surgical patients. There was no significant difference in comfort index between the two groups (stented 34%, surgical 42,5%) Neither was there significant difference in survival and quality of life between palliative resection and bypass surgery. CONCLUSIONS: despite the survival and time free of disease being better in surgical patients, there was no significant difference in overall quality of life between the two groups. The survival and quality of life are the same after palliative resection as after bypass surgery, for this should not be performed routinely or to justify resection as a debulking procedure.
Subject(s)
Bile Duct Neoplasms/surgery , Biliopancreatic Diversion , Jaundice, Obstructive/surgery , Palliative Care , Pancreatic Neoplasms/surgery , Quality of Life , Stents , Aged , Bile Duct Neoplasms/complications , Endoscopy, Digestive System , Female , Humans , Jaundice, Obstructive/etiology , Male , Middle Aged , Pancreatic Neoplasms/complications , Retrospective Studies , Survival AnalysisABSTRACT
A case of cholestasis in a young patient with portal cavernomatosis is reported. This clinical picture is very infrequent and appears as a consequence of extrinsic compression on the common bile duct due to which the derivative venous collaterals. There does not appear to be any relationship between the intensity of the morphologic alteration of the biliary tract and the level of portal hypertension and the degree of extrahepatic obstruction. Diagnosis was fundamentally achieved by arteriography and retrograde cholangiography with differential diagnosis with the previously mentioned diseases being required. Chronic cholestasis advises derivative surgery in which difficulties may be found due to the presence of thick collaterals in the hepatic pedicle as occurred in this patient.
