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Surgical intervention of severe post-ERCP-pancreatitis accompanied with duodenum perforation
Authors:Zuo-bing Chen  Zhong-yan Liang  Yun Zhang  Shao-yang Zhang and Shu-sen Zheng
Institution:(1) Critical Care and Emergency Center, Yokohama City University School of Medicine, 4-57 Urafune, Minami, Yokohama 232-0024, Japan;(2) Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan;(3) Department of Surgical Oncology and Gastroenterological Surgery, Sapporo Medical University Graduate School of Medicine, Sapporo, Japan;(4) Department of Hemodialysis and Surgery, Clinical Research Center, Kaken Hospital, International University of Health and Welfare, Chiba, Japan;(5) Department of Emergency and Critical Care Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan;(6) Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan;(7) General Internal Medicine, Japanese Red Cross Society Nagoya Daini Hospital, Nagoya, Japan;(8) Department of Surgery, Kumamoto Regional Medical Center, Kumamoto, Japan;(9) Department of Gastroenterology, Ogaki Municipal Hospital, Ogaki, Japan;(10) Department of Healthcare Economics and Quality Management, Kyoto University Graduate School of Medicine, Kyoto, Japan;(11) Department of Radiology, Graduate School of Medical Science, Kanazawa University, Ishikawa, Japan;(12) Department of Surgery, National Hospital Organization Sendai Medical Center, Sendai, Japan;(13) Otsu Municipal Hospital, Otsu, Japan;(14) Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan;(15) Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
Abstract:Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure widely used to diagnose and treat conditions of biliary or pancreatic ductal system. The post-ERCP severe acute pancreatitis (SAP) accompanied with duodenum perforation is rare but serious, remaining a challenge in clinic. In this study we report two such cases. Two Chinese women were treated for clinical suspicion of bile duct obstruction and underwent ERCP after admission. Both developed duodenum perforation and SAP after ERCP, and were managed in the intensive care unit (ICU) and required an organ-failure support. The surgical intervention of the peri-pancreatic debridement with lumber-abdominal compound incisions and postoperative washing and drainage was performed, and the two patients recovered well. The therapeutic effect of the peri-pancreatic debridement with lumber-abdominal compound incisions combined with postoperative washing and drainage in the patients of severe post-ERCP-pancreatitis (PEP) and duodenum perforation is satisfactory.
Keywords:Endoscopic retrograde cholangiopancreatography (ERCP)  Post-ERCP-pancreatitis (PEP)  Duodenum perforation  Debridement  Drainage
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