지원사업
학술연구/단체지원/교육 등 연구자 활동을 지속하도록 DBpia가 지원하고 있어요.
커뮤니티
연구자들이 자신의 연구와 전문성을 널리 알리고, 새로운 협력의 기회를 만들 수 있는 네트워킹 공간이에요.
논문 기본 정보
- 자료유형
- 학술저널
- 저자정보
- 발행연도
- 2007.3
- 수록면
- 210 - 215 (6page)
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초록· 키워드
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Purpose: Although duodenal perforation following ERCP is very rare compared to other complications, it can result in a fatal outcome. To find the most effective treatment strategy, the cases experienced at our hospital were reviewed and analyzed.
Methods: A retrospective chart review, conducted at our hospital between December 1994 and April 2006, identified 15 periduodenal perforation cases related to ERCP; a rate of 0.53%. The following parameters were reviewed: clinical presentation of perforation, diagnostic methods, time to diagnosis and operation, method of management, length of stay and outcome.
Results: Fourteen patients were managed by surgery and one conservatively. Eleven patients were cured without complications, but four suffered from severe complications, and required several re-operations. Two patients (50%) of the re-operated group died. The mean time to surgery was longer in the re-operated than non-re-operated group (34.3±12.4 hours vs. 17.2±21.7 hours). The causes for the reoperation were an anastomosis blowout in the duodenotomy for transduodenal sphincteroplasty in 3 and duodenal perforation at the site of transduodenal sphincteroplasty in the remaining patient. All re-operated cases had large retroperitoneal fluid collection, as seen on CT scanning, and had been operated on by inexperienced surgeons.
Conclusion: The early detection is important for the treatment of a duodenal perforation following ERCP. If surgical treatment is needed, it must be performed within 24 hours. Although the type of surgical procedure will depend on the surgeon’s preference, a less invasive procedure, such as simple closure & drainage, will be adequate in cases with a delayed diagnosis, a septic condition or an inexperienced surgeon.
Methods: A retrospective chart review, conducted at our hospital between December 1994 and April 2006, identified 15 periduodenal perforation cases related to ERCP; a rate of 0.53%. The following parameters were reviewed: clinical presentation of perforation, diagnostic methods, time to diagnosis and operation, method of management, length of stay and outcome.
Results: Fourteen patients were managed by surgery and one conservatively. Eleven patients were cured without complications, but four suffered from severe complications, and required several re-operations. Two patients (50%) of the re-operated group died. The mean time to surgery was longer in the re-operated than non-re-operated group (34.3±12.4 hours vs. 17.2±21.7 hours). The causes for the reoperation were an anastomosis blowout in the duodenotomy for transduodenal sphincteroplasty in 3 and duodenal perforation at the site of transduodenal sphincteroplasty in the remaining patient. All re-operated cases had large retroperitoneal fluid collection, as seen on CT scanning, and had been operated on by inexperienced surgeons.
Conclusion: The early detection is important for the treatment of a duodenal perforation following ERCP. If surgical treatment is needed, it must be performed within 24 hours. Although the type of surgical procedure will depend on the surgeon’s preference, a less invasive procedure, such as simple closure & drainage, will be adequate in cases with a delayed diagnosis, a septic condition or an inexperienced surgeon.
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REFERENCES
참고문헌 (12)
참고문헌 신청
1. [학술지(정기간행물)] - Cotton PB / 1991 / Endoscopic shincterotomy complications and their management: an attempt at consensus / Gastrointest Endosc 37 : 383 ~ 393
2. [학술지(정기간행물)] - Dunham F / 1982 / Retroperitoneal perforation following endoscopic sphincterotomy: clinical course and management / Endoscopy 14 : 92 ~ 96
3. [학술지(정기간행물)] - Elder JB / 1988 / Surgical treatment of duodenal ulcer / Postgrad Med J 64 : 54 ~ 59
4. [학술지(정기간행물)] - Lee DG / 2003 / Perforation and others / Korean J Gastrointest Endosc 27 : 321 ~ 325
5. [학술지(정기간행물)] - Stapfer M / 2000 / Management of duodenal perforation after endoscopic retrograde cholangiopancreatography and sphincterotomy / Ann Surg 232 : 191 ~ 198
2. [학술지(정기간행물)] - Dunham F / 1982 / Retroperitoneal perforation following endoscopic sphincterotomy: clinical course and management / Endoscopy 14 : 92 ~ 96
3. [학술지(정기간행물)] - Elder JB / 1988 / Surgical treatment of duodenal ulcer / Postgrad Med J 64 : 54 ~ 59
4. [학술지(정기간행물)] - Lee DG / 2003 / Perforation and others / Korean J Gastrointest Endosc 27 : 321 ~ 325
5. [학술지(정기간행물)] - Stapfer M / 2000 / Management of duodenal perforation after endoscopic retrograde cholangiopancreatography and sphincterotomy / Ann Surg 232 : 191 ~ 198
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UCI(KEPA) : I410-ECN-0101-2013-514-002674339