Successful Trans-Cholecysto-Cystic Duct Common Bile Duct Stenting in a Case of Malignant Obstructive Jaundice

Q4 Medicine
Po Hong Tan, Siti Zulaika Saad, Anuradha Valan, Jonathan Khee Ghee, Norhafizah Ehsan, Kharlina Khairuddin
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引用次数: 0

Abstract

Malignant obstructive jaundice (MOJ) is a disease that could negatively affect patient outcomes. It is treated with Endoscopic Retrograde Cholangiopancreatography (ERCP), Percutaneous Transhepatic Biliary drainage (PTBD), or Endoscopic ultrasound-guided biliary drainage (EUS-BD). We here present a case where malignant obstructive jaundice that failed both ERCP and PTBD achieved successful biliary decompression through trans-cholecysto-cystic duct CBD stenting. A-53-year old female presented to our center with obstructive jaundice secondary to a pancreatic uncinate tumor. Multiple attempts of ERCP and PTBD failed due to difficult cannulation and inadequate dilation of IHD. Furthermore, EUS-BD expertise was not available in our center. A percutaneous cholecystostomy was performed for temporary biliary decompression. After a multidisciplinary discussion was made, the decision was made for trans-cholecystic-cystic duct CBD stenting. The procedure was a success without significant complications. There are multiple ways for biliary decompression. ERCP and PTBD are most commonly used as the first-line treatment with a high success rate. However, PTBD is associated with more complications, with a morbidity rate of up to 33%. With the advancement of EUS, EUS-BD has been a popular treatment option with similar technical success. However, it is a complex and risky procedure that requires expertise. In this case, we achieved a biliary decompression technique similar to PTBD. Instead, the gallbladder and cystic duct are used as passage for stenting. The result is better than envisaged with successful biliary decompression without complications. In conclusion, trans-cholecysto-cystic duct biliary stenting is a feasible procedure to be done for biliary decompression.
恶性梗阻性黄疸经胆囊-胆囊管胆总管支架置入术成功1例
恶性梗阻性黄疸(MOJ)是一种可能对患者预后产生负面影响的疾病。治疗方法包括内镜逆行胆管造影(ERCP)、经皮经肝胆道引流术(PTBD)或内镜超声引导胆道引流术(EUS-BD)。我们在此报告一例恶性梗阻性黄疸,ERCP和PTBD均失败,通过经胆囊-胆囊管CBD支架成功实现了胆道减压。一名53岁女性,因胰脏钩状肿瘤继发梗阻性黄疸就诊。由于插管困难和IHD扩张不足,多次尝试ERCP和PTBD均失败。此外,我们中心没有EUS-BD专业知识。采用经皮胆囊造瘘术进行临时胆道减压。经过多学科讨论,我们决定采用经胆囊-胆囊管CBD支架植入术。手术很成功,没有明显的并发症。胆道减压有多种方法。ERCP和PTBD是最常用的一线治疗方法,成功率高。然而,PTBD与更多并发症相关,发病率高达33%。随着EUS的进步,EUS- bd已成为一种流行的治疗选择,并取得了类似的技术成功。然而,这是一个复杂而危险的过程,需要专业知识。在本例中,我们采用了类似于PTBD的胆道减压技术。相反,胆囊和胆囊管被用作支架置入的通道。胆道减压成功,无并发症,效果好于预期。总之,经胆囊-胆囊管胆道支架置入术是一种可行的胆道减压手术。
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来源期刊
Surgery, Gastroenterology and Oncology
Surgery, Gastroenterology and Oncology Medicine-Gastroenterology
CiteScore
0.30
自引率
0.00%
发文量
11
期刊介绍: Starting with this issue "Annals of Fundeni Hospital", founded in 1996 as the scientific journal of the prestigious hospital Fundeni becomes "Journal of Translational Medicine and Research" (JTMR), an Journal of the Academy of Medical Sciences of Romania. Therefore, an 18 years old Journal, attested and indexed in Elsevier Bibliographic Databases, Amsterdam and also indexed in SCOPUS, is continuing a tradition of excellence that lasted almost two decades. The new title of the Journal is inspired first of all from the important developments of translational research In Fundeni Clinical Institute and the "C.C Iliescu Institute for Cardio-Vascular Diseases", in parallel with the national and international trend to promote and develop this important area or medical research. Although devoted mainly to translational research, JTMR will continue to promote both basic and clinical research.
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