The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
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A Case of Percutaneous Transhepatic Gallbladder Papillary Balloon Dilatation

경피경간 담낭 배액로를 통한 유두부 풍선 확장술 1예

  • Kim, Dae Young (Digestive Disease Center, CHA Bundang Medical Center, CHA University) ;
  • Kwon, Chang-Il (Digestive Disease Center, CHA Bundang Medical Center, CHA University) ;
  • Jeon, Gyeong Sik (Digestive Disease Center, CHA Bundang Medical Center, CHA University) ;
  • Yoo, Jeong Hwan (Digestive Disease Center, CHA Bundang Medical Center, CHA University) ;
  • Yoon, Harry (Digestive Disease Center, CHA Bundang Medical Center, CHA University) ;
  • Lee, Jeong Guil (Digestive Disease Center, CHA Bundang Medical Center, CHA University) ;
  • Son, Myung Su (Digestive Disease Center, CHA Bundang Medical Center, CHA University)
  • 김대영 (차의과학대학교 분당차병원 소화기센터) ;
  • 권창일 (차의과학대학교 분당차병원 소화기센터) ;
  • 전경식 (차의과학대학교 분당차병원 소화기센터) ;
  • 유정환 (차의과학대학교 분당차병원 소화기센터) ;
  • 윤해리 (차의과학대학교 분당차병원 소화기센터) ;
  • 이정길 (차의과학대학교 분당차병원 소화기센터) ;
  • 손명수 (차의과학대학교 분당차병원 소화기센터)
  • Received : 2013.02.06
  • Accepted : 2013.04.08
  • Published : 2014.02.01
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Abstract

Endoscopic retrograde cholangiopancreatography (ERCP) fails occasionally due to a surgically altered anatomy, periampullary diverticulum, difficult cannulation, or poor general condition of the patient. In these cases, alternative treatment options are necessary, including percutaneous transhepatic biliary drainage (PTBD) or percutaneous transhepatic gallbladder biliary drainage (PTGBD). Here, we report a case of cholangitis treated with percutaneous transhepatic gallbladder papillary balloon dilatation (PTGBPBD). A 61-year-old male was admitted for cholangitis associated with biliary sludge. ERCP cannulation had failed due to the position of the papilla within a large periampullary diverticulum, and PTBD had failed due to a non-dilated intrahepatic bile duct. Following PTGBD, papillary balloon dilatation was completed successfully through the PTGBD tract. The patient tolerated the procedure and was discharged without complications. We conclude that PTGBPBD is an acceptable and safe procedure in a patient with cholangitis who underwent failed ERCP or PTBD procedures.

담관 결석을 동반한 담관염에 대한 치료 방법으로 우선적으로 권고되는 내시경역행췌담관조영술(endoscopic retrograde cholangiopancreato-graphy, ERCP)은 위절제술, 십이지장 게실 등으로 인한 해부학적 변화 등으로 인해 임상적으로 시행할 수 없는 경우가 있다. 이런 환자에서 대체 방법으로 경피간 경유 경로를 통한 유두부 풍선 확장술(pneumatic balloon dilatation, PBD)을 시행할 수 있다. 그러나 본 환자는 간 속 담관 확장도 없어 경피간경유담관배액술(percutaneous transhepatic biliary drainage, PTBD) 또한 시행할 수 없었던 드문 증례로 PTGBD 경로를 통해 풍선 카테터를 유두부에 삽입하여 PBD를 시행하여 성공적으로 담관염이 호전되었고 특별한 합병증 없이 퇴원하였다. PTGBD 경로를 통한 PBD는 담관 내 결석등에 의한 담관염 치료를 위해 이용될 수 있는 대체 치료 방법이다.

Keywords

References

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