Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
권호 표지

A Primary Repair with Hemoclips and Fibrin Glue Injection in Biliary Stent Induced Duodenal Perforation

담도 스텐트 이탈에 의한 십이지장 천공 환자에서 지혈클립과 Fibrin Glue를 이용한 내시경 치료 1예

  • Kim, Ki-Won (Department of Internal Medicine, Cheonan Hospital, Soonchunhyang University College of Medicine) ;
  • Lee, Tae-Hoon (Department of Internal Medicine, Cheonan Hospital, Soonchunhyang University College of Medicine) ;
  • Park, Sang-Heum (Department of Internal Medicine, Cheonan Hospital, Soonchunhyang University College of Medicine) ;
  • Son, Bum-Suk (Department of Internal Medicine, Cheonan Hospital, Soonchunhyang University College of Medicine) ;
  • Lee, Sae-Hwan (Department of Internal Medicine, Cheonan Hospital, Soonchunhyang University College of Medicine) ;
  • Lee, Suck-Ho (Department of Internal Medicine, Cheonan Hospital, Soonchunhyang University College of Medicine) ;
  • Chung, Il-Kwun (Department of Internal Medicine, Cheonan Hospital, Soonchunhyang University College of Medicine) ;
  • Kim, Sun-Joo (Department of Internal Medicine, Cheonan Hospital, Soonchunhyang University College of Medicine)
  • 김기원 (순천향대학교 의과대학 천안병원 소화기내과학교실) ;
  • 이태훈 (순천향대학교 의과대학 천안병원 소화기내과학교실) ;
  • 박상흠 (순천향대학교 의과대학 천안병원 소화기내과학교실) ;
  • 손범석 (순천향대학교 의과대학 천안병원 소화기내과학교실) ;
  • 이세환 (순천향대학교 의과대학 천안병원 소화기내과학교실) ;
  • 이석호 (순천향대학교 의과대학 천안병원 소화기내과학교실) ;
  • 정일권 (순천향대학교 의과대학 천안병원 소화기내과학교실) ;
  • 김선주 (순천향대학교 의과대학 천안병원 소화기내과학교실)
  • Published : 2011.06.30
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Abstract

Duodenal perforations caused by biliary prostheses are uncommon, but they are potentially life threatening and require immediate treatment. Here we describe an unusual case of duodenal perforation induced by a plastic biliary stent. It masqueraded as a case of cholecystitis and combined systemic upset with a localized peritonitis and fever. Primary endoscopic closure by hemoclips was difficult due to the position of the lateral wall and the complexity of aligning the perforation with the endoscope. To approximate the perforated hole and adherent hemoclips, glue injection and sprayings were successfully performed under cap-fitted endoscopy. The patient recovered without additional complications.

치료적 ERCP 시술에서 금속 또는 플라스틱 담도 스텐트에 의한 십이지장 천공은 비교적 드문 합병증이나 매우 치명적인 결과를 초래할 수 있는 합병증으로 즉각적인 진단과 수술적 치료를 요한다. 저자들은 담도 스텐트 삽입 후 초기에 담낭염으로 오인되어 경피경간 담낭배액술을 시행하였으나, 플라스틱 담도 스텐트 이탈에 의한 십이지장 천공과 이로 인한 국소적 복막염으로 최종 진단된 72세 남자에서 내시경 치료를 시도하였다. 일차적인 내시경 봉합술을 위해 내시경 선단에 투명캡을 장착 후 지혈클립을 이용해 봉합하였으나 천공 위치로 인해 완전한 봉합이 이루어지지 않아 일차 봉합한 점막에 fibrin glue의 주입과 도포를 시행해 성공적으로 치료한 증례를 보고하고자 한다.

Keywords

References

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