时间:2018-08-10 作者:翻译:王浩 审校:张 点击:


(注:本篇报道病例患者在怀疑脾损伤后进行了急诊剖腹探查术emergent laparotomy,术中施行了脾切除和胆囊切除,患者术后恢复顺利,在ERCP术后11天时出院。)

Etiologies and risks of splenic decapsulation after endoscopic retrograde cholangiopancreatography: case report and literature review

Background and study aims Endoscopic retrograde cholangiopancreatography (ERCP) is an invasive diagnostic and interventional procedure used in conditions related to the pancreas and biliary tract. It has a complication rate ranging from 4 % to 10 %. Severe complications are few with the most common of them being post-ERCP pancreatitis, post-sphincterotomy bleeding, and perforation. A rare, but potentially life-threatening complication of ERCP is splenic injury. We report the case of a 60-year-old female with choledocholithiasis who sustained splenic decapsulation following ERCP. The exact causes of splenic injury are unknown, although several mechanisms are postulated. A literature review of splenic injuries post-ERCP shows that there are only 3 cases with post-ERCP splenic decapsulation. Our patient is the first one in whom splenic decapsulation occurred without any risk factors or technical difficulties during the procedure. A high index of suspicion for splenic injury is required in any patient who has severe pain, anemia, or hemorrhagic shock after ERCP.

Conclusion Splenic injury is a rare complication of ERCP. Although most patients recover completely, that complication can be fatal. It is important to consider splenic injury in any patient after ERCP who has increasing abdominal pain ,develops anemia or sever hypotension. These symptoms can present immediately or even days after the procedure. It is important to realize that this complication may occur even if ERCP was performed with no technical difficulty or risk factors. 

翻译:王浩 审校:张立超 侯森林  (Endosc Int Open 2018)