ABSTRACT
Selective biliary cannulation is an essential prerequisite for therapeutic endoscopic retrograde cholangiopancreatography (ERCP). The cap-fitted forward-viewing endoscope has been used for ERCP in patients with surgically altered anatomy. In this case series, 12 patients with periampullary diverticulum underwent ERCP using the cap-assisted forward-viewing endoscope due to failure of biliary cannulation using the standard technique. Successful ERCP was achieved in all patients with no serious complications.
Subject(s)
Ampulla of Vater/surgery , Cholangiopancreatography, Endoscopic Retrograde/instrumentation , Diverticulum/surgery , Endoscopes , Aged , Aged, 80 and over , Bile Duct Neoplasms/diagnosis , Bile Duct Neoplasms/surgery , Catheterization/methods , Cholangiopancreatography, Endoscopic Retrograde/methods , Choledocholithiasis/diagnosis , Choledocholithiasis/surgery , Cohort Studies , Equipment Design , Female , Hepatic Duct, Common/surgery , Humans , Klatskin Tumor/diagnosis , Klatskin Tumor/surgery , Male , Middle Aged , Retrospective Studies , Treatment OutcomeABSTRACT
Colocolic fistulas are usually a complication of an inflammatory or neoplastic process. Development of these abnormal bowel communications may lead to bacterial overgrowth. We report on a 71-year-old man with a one-year history of recurrent abdominal distension and irregular bowel habits. Abdominal X-rays and computed tomography showed multiple air-fluid levels and loops of distended bowel without evidence of mechanical obstruction or diverticulitis. Colonoscopy showed a fistulous tract between the sigmoid colon and cecum. Results of a lactulose breath test showed high fasting breath CH4 levels, which were thought to be the result of intestinal bacterial overgrowth. The patient was diagnosed with a colonic pseudo-obstruction associated with bacterial overgrowth due to a sigmoidocecal fistula. We recommended surgical correction of the sigmoidocecal fistula; however, the patient requested medical treatment. After antibiotic therapy, the patient still had mild symptoms but no acute exacerbations.
