Article Text

Download PDFPDF
CASE REPORT
Oesophageal stent placement to treat a massive iatrogenic duodenal defect after laparoscopic cholecystectomy
  1. Alissa Greenbaum1,
  2. Gulshan Parasher2,
  3. Gerald Demarest1,
  4. Edward Auyang1
  1. 1 Department of Surgery, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
  2. 2 Division of Gastroenterology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
  1. Correspondence to Alissa Greenbaum, agreenbaum{at}salud.unm.edu

Summary

Iatrogenic duodenal injury occurring during laparoscopic cholecystectomy (LC) is managed surgically, though rarely a large, persistent fistula is refractory to surgical interventions. We present the case of a 40-year-old woman transferred to our centre following elective LC for a reported perforated duodenal ulcer. An uncontained leak was found to originate from a 1.5 cm duodenal defect, with no evidence of ulceration. A duodenostomy tube was placed. One month after abdominal closure, the patient continued to have a persistent, large duodenal fistula. A through-the-scope covered oesophageal stent was placed under endoscopic and fluoroscopic guidance. Five weeks later, it was successfully retrieved and no subsequent extravasation of contrast from the duodenum was noted. Unrecognised iatrogenic duodenal injuries sustained during LC can be catastrophic. In cases of massive duodenal defects and high-output biliary fistula uncontrolled after surgical intervention, endoscopic-guided and fluoroscopic-guided placement of a fully covered oesophageal stent may be lifesaving.

  • Biliary intervention
  • GI stents
  • Endoscopy
  • Gastrointestinal surgery
  • General surgery
View Full Text

Statistics from Altmetric.com

Footnotes

  • Contributors AG contributed to project conception and wrote the manuscript. GP, EA and GD contributed to project conception, and revised and approved the final manuscript.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.