Operative and non-operative management of endoscopic retrograde cholangiopancreatography-associated duodenal injuries
| Autor: | Hussein Ageely, Ahmad El Hadad, M Ezzedien Rabie, M Obaid, N H Mir, Abdul Nasser Shaban, Abdelelah Hummadi, I El Hakeem, M S Al Skaini |
|---|---|
| Rok vydání: | 2013 |
| Předmět: |
Adult
Male medicine.medical_specialty Duodenum Digestive System Diseases medicine.medical_treatment Perforation (oil well) Patient age Laparotomy medicine Humans Contrast extravasation Aged Retrospective Studies Aged 80 and over Cholangiopancreatography Endoscopic Retrograde Endoscopic retrograde cholangiopancreatography medicine.diagnostic_test business.industry Retrospective cohort study General Medicine Middle Aged Surgery Conservative treatment Intestinal Perforation HPB Radiological weapon Female Tomography X-Ray Computed business |
| Zdroj: | The Annals of The Royal College of Surgeons of England. 95:285-290 |
| ISSN: | 1478-7083 0035-8843 |
| DOI: | 10.1308/003588413x13511609958578 |
| Popis: | Introduction Endoscopic retrograde cholangiopancreatography (ERCP) is indispensable in everyday surgical practice. Despite this, as an invasive procedure, it has its own mortality and morbidity, the most feared of which is periduodenal perforations. Our experience with ERCP related periduodenal perforations and its treatment strategies are presented. Additionally, a rarely encountered subtype is highlighted. Methods Patients who underwent ERCP and sustained a periduodenal perforation between August 2008 and October 2011 were reviewed. Results During the period from August 2008 to October 2011, 597 ERCP procedures were performed in our hospital. Ten of these patients (3 male, 7 female) had a perforation. The mean patient age was 56.6 years. During the procedure, injury was suspected in four patients; it passed unnoticed in the remaining six. The decision to operate or follow a conservative policy was based on a combination of clinical and radiological findings. Operative intervention was required in three patients, with one mortality, while conservative treatment was followed in the remaining seven. A laparotomy was performed early in two patients whereas it was performed after an initial period of conservative treatment in one. The presence of periduodenal fluid collection, contrast extravasation or free intraperitoneal air were decisive factors for performing laparotomy. Conclusions ERCP-related periduodenal perforations include different categories. Certain types require operative repair while others should be treated conservatively. The choice of the management approach should be individualised, depending on the clinical picture and radiological findings. Although rare, these are potentially serious complications that may end fatally. Early recognition and appropriate intervention is the only way to avert a fatal outcome. |
| Databáze: | OpenAIRE |
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