Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
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Magnet Compression Anastomosis for Bilioenteric Anastomotic Stricture after Removal of a Choledochal Cyst: A Case Report

담관 낭종 절제 후 발생한 문합부 협착을 자석 압박 문합술로 치료한 1예

  • Lim, Hyun-Chul (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Lee, Dong-Ki (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Choi, Hong-Kyu (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Jung, Kyo-Tae (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Lee, Keun-Man (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Jahng, Jae-Hoon (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Park, Joon-Sung (Department of Surgery, Yonsei University College of Medicine) ;
  • Won, Jong-Yun (Department of Radiology, Yonsei University College of Medicine)
  • 임현철 (연세대학교 의과대학 내과학교실) ;
  • 이동기 (연세대학교 의과대학 내과학교실) ;
  • 최홍규 (연세대학교 의과대학 내과학교실) ;
  • 정교태 (연세대학교 의과대학 내과학교실) ;
  • 이근만 (연세대학교 의과대학 내과학교실) ;
  • 장재훈 (연세대학교 의과대학 내과학교실) ;
  • 박준성 (연세대학교 의과대학 외과학교실) ;
  • 원종윤 (연세대학교 의과대학 영상의학교실)
  • Received : 2009.10.07
  • Accepted : 2010.08.17
  • Published : 2010.09.30
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Abstract

Magnet compression anastomosis is a nonsurgical method that uses two magnets to treat bilio-biliary and bilio-enteric anastomotic strictures after a living donor transplantation. The compression pressure of the two magnets induces ischemic necrosis at the anastomostic stricture and creates a fistula at the stricture site. A choledochal cyst is an uncommon congenital anomaly characterized by dilatation of the biliary tree and can cause obstructive jaundice, cholangitis, biliary stones, and cholangiocelluar carcinoma. Treatment for choledochal cyst is essentially surgical including total excision of the cyst with hepaticoenterostomy, but there can be complications such as postoperative intrahepatic stones and recurrent cholangitis due to a stricture at the site of the anastomosis. Endoscopic and fluoroscopy-guided radiologic interventions can be applied to resolve the anastomotic stricture, and re-operation is possible as the method of last resort. We report here a first case, trial magnet compression anastomosis in Korea of a bilioenteric anastomotic stricture after excision of a choledochal cyst and hepaticojejunostomy.

자석 압박 문합술은 주로 생체간이식환자에서 발생하는 총담관간 단단문합술 또는 총담관-공장문합술 후 발생한 문합부 협착을 두 개의 자석을 이용하여 치료하는 비수술적 방법이다. 두 개의 자석의 압박은 협착부분의 허혈성 괴사를 통한 누공을 형성하여 새로운 문합구를 형성하도록 한다. 담관 낭종은 드문 선천적 질환으로 간내 또는 간외 담관의 확장을 특징으로 하며 패쇄성 황달, 담관염, 담석, 담관암을 유발할 수 있다. 담관 낭종의 치료는 낭종의 완전 절제 및 간관-공장-공장 문합술을 시행하고 있으나, 수술 후 분합부 협착에 의한 간내 담석, 반복적인 담관염이 발생할 수 있다. 협착의 치료를 위하여 내시경적 또는 방사선학적 시술을 시행할 수 있으며, 재수술을 통한 치료는 마지막 방법으로 시도할 수 있다. 저자들은 담관 낭종 절제술 후 문합부 협착에 의한 반복적인 담관염을 주소로 내원하여 자석 압박 문합술로 치료한 증례를 국내에서 처음으로 경험하여 보고한다.

Keywords

References

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