|
|
-Case Reports-
Early Surgical Management for Periampullary Retroperitoneal Perforation Caused by Endoscopic Sphincterotomy: A Report of a Case
1Surgery for Organ Function and Biological Regulation, Graduate School of Medicine, Nippon Medical School
2Department of Medicine and Clinical Oncology Graduate of Medicine Chiba University
A 67-year-old woman was admitted to our hospital for surgical management of cancer of the ascending colon. On admission, she had cholangitis due to choledocholithiasis. Abdominal computed tomography, ultrasonography, and magnetic resonance showed cholelithiasis, choledocholithiasis, and multiple liver tumors. Colonoscope showed advanced cancer of the ascending colon. Because of acute obstructive suppurative cholangitis, endoscopic sphincterotomy was performed. During the procedure, periampullary retroperitoneal perforation was identified on radiologic examination. Because computed tomography had shown extravasation of contrast medium and widespread pneumoretroperitoneum, an emergency operation was performed 2 hours after perforation. After cholecystectomy and choledocholithotomy had been performed and all bile duct stones had been removed, periampullary perforation was readily identified close to the duodenal diverticula and easily repaired. The postoperative course was uneventful. This patient could resume oral feeding soon after the operation, and colonic surgery could be performed immediately thereafter. Therefore, early surgical management is a possible first choice of treatment in patients with remaining biliary disease after periampullary perforation.
J Nippon Med Sch 2008; 75: 298-301
Keywords
periampullary retroperitoneal perforation, surgical treatment, endoscopic sphincterotomy
Correspondence to
Takayuki Aimoto, MD, Department of Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
aimoto@nms.ac.jp
Received, May 13, 2008
Accepted, June 3, 2008
PDF (355K)