Unpredictable Event during EUS-Guided Hepaticojejunostomy

Year 2023, Volume: 25 Issue: 1, 89 - 91, 30.04.2023

Abdullatif Sirin , Mehmet Çetin , Salih Tokmak

https://doi.org/10.18678/dtfd.1207166

Abstract

Endoscopic ultrasound (EUS)-guided biliary drainage is a therapeutic alternative method in patients with cholestasis where the ampulla of Vater cannot be reached because several reasons. An unfortunate complication during EUS-guided biliary drainage was presented in this report. A 53-year-old male patient presented with jaundice and pruritus. He had a history of total gastrectomy due to gastric cancer. An abdominal tomography scan detected a tumoral mass in the common bile duct due to the recurrence of gastric cancer. We decided to perform EUS-guided hepaticojejunostomy because biliary drainage cannot be obtained by conventional methods and percutaneous drainage impairs patient comfort. A double pigtail plastic stent was placed from the jejunum into the segment-3 bile duct towards the hilus. After that echoduodenoscope was removed to the outside gently. We noticed that the stent was stuck in the echoduedonoscope elevator. We reached into the bile duct again and placed a double-pigtail plastic stent successfully.

Keywords

Cholestasis, Extrahepatik Cholestasis, Endoscopic Ultrasound (EUS)

EUS Kılavuzluğundaki Hepatikojejunostomi Sırasında Öngörülemeyen Olay

Abstract

Kolestazı olan hastalarda ampulla Vateri’ye çeşitli nedenlerde erişilemediği durumlarda endoskopik ultrason (EUS) kılavuzluğunda biliyer drenaj alternatif bir terapötik yöntemdir. Bu raporda, EUS kılavuzluğunda biliyer drenaj sırasında talihsiz bir komplikasyonun bildirilmektedir. 53 yaşında erkek hasta sarılık ve kaşıntı şikayeti ile başvurdu. Mide kanseri nedeniyle total gastrektomi öyküsü mevcuttu. Abdomen tomografisinde mide kanseri nüksüne bağlı gelişen peritoneal karsinamoza bağlı koledokta tümöral kitle saptandı. Biliyer drenajın konvansiyonel yöntemlerle sağlanamaması ve perkütan drenajın hasta konforunu bozması nedeniyle EUS eşliğinde hepatikojejunostomi yapılmasına karar verildi. Jejunumdan segment-3 safra yoluna hilusa uzanacak şekilde double pigtail plastik stent yerleştirildi. Ardından ekoduedonoskop yavaşça dışarıya çıkarıldı. Stentin ekoduedonoskopun kaldıracına takıldığı fark edildi. Safra kanalına tekrar ulaşıldı ve bir double-pigtail plastik stent başarıyla yerleştirildi.

Keywords

Kolestaz, Ekstrahepatik Kolestaz, Endoskopik Ultrason(EUS)

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