摘要
Abstract
Objective To investigate the clinical features of peripancreatic pseudoaneurysm (PPA) caused by endoscopic retrograde cholangiopancreatography (ERCP) combined with endoscopic sphincterotomy (EST) and its preventive measures. Methods A retrospective analysis was made on the clinical data of a patient with PPA com-plicated with severe gastrointestinal bleeding caused by ERCP combined with EST for common bile duct stones com-plicated with acute cholangitis. Results In this study, the patient was admitted to the hospital due to paroxysmal right upper abdominal pain for one day. Lower common bile duct lithiasis with acute cholangitis was clearly diagnosed by magnetic resonance cholangiopancreatography and then EST surgery was carried out under ERCP. On the 2nd postoperative day, the patient developed hematemesis and hematochezia which were gradually exacerbated. Digital subtraction angiography (DSA) was performed immediately due to poor efficacy of hemostasis and blood transfusions, and pseudoaneurysm of the pancreaticoduodenal artery with leakage of contrast agent was confirmed. Laparotomy, in-cision and exploration of descending part of duodenum, combined with the duodenal papillary hemostasis, duodenal papilloplasty and peritoneal drainage were carried out immediately. The patient recovered well postoperatively and was discharged home, which, however, led to medical disputes. The forensic physicians believed that there were cer-tain negligences on medical diagnosis and treatment behaviors, which was responsible for the malignant medical con-sequences, including PPA complicated with severe gastrointestinal bleeding and hemorrhagic shock after surgery. Conclusion Adequate preoperative preparation, reasonable lithiasis removal strategy, and comprehensive postopera-tive monitoring are important measures to avoid the occurrence of iatrogenic PPA and severe gastrointestinal bleeding after biliary endoscopy.关键词
动脉瘤,假性/胰胆管造影术,内窥镜逆行/括约肌切开术,内窥镜/胆总管结石/胆囊炎,急性Key words
Aneurysm/false/Cholangiopancreatography/endoscopic retrograde/Sphincterotomy,endo-scopic/Choledocholithiasis/Cholecystitis,acute分类
医药卫生
