2개의 내시경을 이용한 금속 스텐트 삽입술을 통해 치료한 들창자 증후군
A Case of Afferent Loop Syndrome Treated by Endoscopic Metal Stent Insertion Using Two Endoscopes
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
들창자 증후군의 비수술적 치료 방법은 다양하지만 언제나 모든 방법이 다 적용 가능한 것은 아니다. 특히 내시경적치료 방법은 해부학적 변형으로 인해 병변으로의 접근에 제한점이 있다. 이에 저자들은 악성 종양으로 인한 들창자 증후군 환자에서 2개의 내시경을 이용하여 성공적으로 금속스텐트를 삽입한 사례를 문헌 고찰과 함께 보고하는 바이다.
Abstract
Afferent loop syndrome is a rare complication of pancreaticoduodenectomy, and the endoscopic approach is difficult due to the surgically altered anatomy. Herein, we report a case of afferent loop obstruction treated by endoscopic metal stent insertion using two endoscopes. A 57-year-old male who had undergone the Whipple operation 7 months prior for pancreatic head cancer presented with abdominal pain and jaundice. Abdominal computed tomography showed afferent loop obstruction due to recurrent metastatic pancreatic cancer. First, we attempted to insert the stent using percutaneous transhepatic approaches following percutaneous transhepatic biliary drainage, but these failed. We therefore accessed the obstruction site using a relatively thin endoscope and then exchanged this endoscope for another with a large working channel, through which the self-expandable metal stent was passed. The stent was inserted successfully. This method will increase the success rate of endoscopic treatment.
참고문헌 (10)
- 박경식, "위 수술 후 급·만성 위장관 장애: 기질적 vs. 기능성", 대한내과학회지, 78(2), pp.170~176 (2010), 대한내과학회
- Aimoto T, "Malignant afferent loop obstruction following pancreaticoduodenectomy: report of two cases", J Nippon Med Sch, 73, pp.226~230 (2006)
- Burdick JS, "Endoscopic management of afferent loop syndrome of malignant etiology", Gastrointest Endosc, 55, pp.602~605 (2002)
- Spiliotis J, "Acute cholangitis due to afferent loop syndrome after a Whipple procedure: a case report", Cases J, 2, pp.6339~ (2009)
- Edge S, "AJCC Cancer Staging Manual" (2010), Springer
- 정영욱, "악성 폐쇄성 황달에서 경피적인 십이지장 유두부 통과 스텐트의 안정성 평가: 췌장염 발생 위험도와 선행적 유두부 괄약근 절개술의 의미를 중심으로", 대한소화기학회지, 54(6), pp.390~394 (2009), 대한소화기학회
- Hosokawa I, "Percutaneous transhepatic metallic stent insertion for malignant afferent loop obstruction following pancreaticoduodenectomy:a case report", J Med Case Rep, 6, pp.198~ (2012)
- 김재경, "Endoscopic Management of Afferent Loop Syndrome after a Pylorus Preserving Pancreatoduodenecotomy Presenting with Obstructive Jaundice and Ascending Cholangitis", Clinical Endoscopy, 44(1), pp.59~64 (2011), 대한소화기내시경학회
- Skinner M, "ERCP with the overtube-assisted enteroscopy technique:a systematic review", Endoscopy, 46, pp.560~572 (2014)
- Itokawa F, "Single- and double-balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography in patients with Roux-en-Y plus hepaticojejunostomy anastomosis and Whipple resection", Dig Endosc, 26(Suppl 2), pp.136~143 (2014)