腹腔镜胆囊切除术后Strasberg D型胆管损伤的内镜修复：一种非传统的方法

Q3 Medicine

VideoGIE Pub Date : 2025-10-01 DOI:10.1016/j.vgie.2025.05.009

Ahmad Abdulraheem MD , Angela Koomson MD , Abdalla Khouqeer MD , Ahmad Al-Dwairy MD , Walid Chalhoub MD

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引用次数: 0

摘要

背景与目的胆管损伤（BDI）是腹腔镜胆囊切除术（LC）中一种罕见但严重的不良事件。使用成像和内窥镜工具及时诊断是必不可少的。虽然大多数轻微的bdi （Strasberg型A-C）可以用ERCP治疗，但严重的损伤（D型和E型）通常需要手术干预。该病例采用了一种非常规的方法，仅用ERCP就成功治疗了Strasberg D型损伤。方法我们报告1例Strasberg D型BDI， ERCP合并塑料支架置入术治疗Mirizzi综合征。1天后，LC术中发现总胆管（CBD）损伤，支架置入。结果重复sercp，导丝通过壶腹重新连接截断的CBD。搭桥支架恢复了胆汁流动。MRCP证实无渗漏，4周时CT显示胆囊瘤完全溶解。患者因胆漏及狭窄评估而错过ERCP随访。该病例挑战了目前建议在72小时内对严重bdi进行肝空肠造口术的指南，提示ERCP可能在某些病例中提供非手术替代方案。MRCP可以作为确认修复成功的有价值的工具，并指导非手术治疗方法的术后评估。

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Endoscopic repair of Strasberg type D bile duct injury following laparoscopic cholecystectomy: an unconventional approach

Background and Aims

Bile duct injury (BDI) is a rare but serious adverse event of laparoscopic cholecystectomy (LC). Prompt diagnosis using imaging and endoscopic tools is essential. Although most minor BDIs (Strasberg types A-C) might be managed with ERCP, major injuries (types D and E) typically require surgical intervention. This case highlights an unconventional approach in which a Strasberg type D injury was successfully managed with ERCP alone.

Methods

We present a case of Strasberg type D BDI following ERCP with plastic stent placement for Mirizzi’s syndrome. One day later, during LC, common bile duct (CBD) injury occurred with the stent seen intraoperatively.

Results

ERCP was repeated, and a guidewire was advanced through the ampulla to reconnect the transected CBD. A bridging stent restored bile flow. MRCP confirmed no leak, and CT at 4 weeks showed complete resolution of the biloma. The patient missed ERCP follow-up for bile leak and stricture evaluation.

Conclusions

This case challenges current guidelines recommending hepaticojejunostomy for major BDIs within 72 hours, suggesting ERCP may offer a nonsurgical alternative in select cases. MRCP may serve as a valuable tool for confirming repair success and guiding postprocedural assessment in such nonoperative management approaches.

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来源期刊

VideoGIE Medicine-Gastroenterology

CiteScore

1.50

自引率

0.00%

发文量

132

审稿时长

105 days

期刊介绍： VideoGIE, an official video journal of the American Society for Gastrointestinal Endoscopy, is an Open Access, online-only journal to serve patients with digestive diseases. VideoGIE publishes original, single-blinded peer-reviewed video case reports and case series of endoscopic procedures used in the study, diagnosis, and treatment of digestive diseases. Videos demonstrate use of endoscopic systems, devices, and techniques; report outcomes of endoscopic interventions; and educate physicians and patients about gastrointestinal endoscopy. VideoGIE serves the educational needs of endoscopists in training as well as advanced endoscopists, endoscopy staff and industry, and patients. VideoGIE brings video commentaries from experts, legends, committees, and leadership of the society. Careful adherence to submission guidelines will avoid unnecessary delays, as incomplete submissions may be returned to the authors before initiation of the peer review process.