A Rare Fatal Bile Peritonitis after Malposition of Endoscopic Ultrasound-Guided 5-Fr Naso-Gallbladder Drainage
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초록
Endoscopic ultrasound (EUS)-guided gallbladder (GB) drainage has recently emerged as a more feasible treatment than percutaneoustranshepatic GB drainage for acute cholecystitis. In EUS-guided cholecystostomies in patients with distended GBs withoutpericholecystic inflammation or prominent wall thickening, a needle puncture with tract dilatation is often difficult. Guidewiresmay slip during the insertion of thin and flexible drainage catheters, which can also cause the body portion of the catheter to beunexpectedly situated and prolonged between the GB and intestines because the non-inflamed distended GB is fluctuant. Uponfluoroscopic examination during the procedure, the position of the abnormally coiled catheter may appear to be correct in patientswith a distended stomach. We experienced such an adverse event with fatal bile peritonitis in a patient with GB distension suggestive ofmalignant bile duct stricture. Therefore, the endoscopist should confirm the indications for cholecystostomy and determine whether adistended GB is a secondary change or acute cholecystitis.
Abstract
Endoscopic ultrasound (EUS)-guided gallbladder (GB) drainage has recently emerged as a more feasible treatment than percutaneoustranshepatic GB drainage for acute cholecystitis. In EUS-guided cholecystostomies in patients with distended GBs withoutpericholecystic inflammation or prominent wall thickening, a needle puncture with tract dilatation is often difficult. Guidewiresmay slip during the insertion of thin and flexible drainage catheters, which can also cause the body portion of the catheter to beunexpectedly situated and prolonged between the GB and intestines because the non-inflamed distended GB is fluctuant. Uponfluoroscopic examination during the procedure, the position of the abnormally coiled catheter may appear to be correct in patientswith a distended stomach. We experienced such an adverse event with fatal bile peritonitis in a patient with GB distension suggestive ofmalignant bile duct stricture. Therefore, the endoscopist should confirm the indications for cholecystostomy and determine whether adistended GB is a secondary change or acute cholecystitis.
참고문헌 (16)
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