Non-Operative Treatment of Choledochoduodenocutaneous Fistula in a Post Billroth Ⅱ Gastrectomy Patient: A Case Report

總膽管十二指腸皮下瘻管之非手術性療法：一病例報告

林連福(Lien-Fu Lin) ； 蕭泉豹(Chuan-Pau Siauw) ； 何家奭(Ka-Sic Ho) ； 童瑞欽(Jai-Chin Tung)

《中華民國消化系醫學雜誌》 14卷4期 (1997/12) Pp. 331-337

https://doi.org/10.6557/GJTb.199712_14(4).0003

摘要

一位六十六歲女性病患，於六年前因膽結石接受膽囊切除術，於三年前因總膽管結石接受內視鏡乳突切開取石術，於二年前因左葉肝內結石接受肝臟左葉外側切除術。之後因殘留左葉肝內膽管狹窄造成肝管皮下瘻管，而接受肝臟左葉內側切除術。
此次住院因頑固性十二指腸潰瘍及先前引流傷口有滲出液，接受畢耳羅氏第二型胃切除及T管引流。後來因引流處有膽汁滲出，經內視鏡逆行膽管攝影檢查結果為總膽管十二指腸皮下瘻管。非手術性治療包括禁食，全靜脈營養，體抑素靜脈注射，總膽管內置管，及鼻膽管引流術後，皮下瘻管癒合。

關鍵字

膽道瘻管 ； 總膽管十二指腸皮下瘻管 ； 膽管內置管

並列摘要

A 66-year-old female patient had three operations performed in other hospitals, namely cholecystectomy, left lateral segmentectomy, and left medial segmentectomy of liver. She was then admitted for severe refractory duodenal ulcer and little discharge from the previous drainage wound. During the operation, localized perforation of duodenal ulcer and choduodenal fistula were found, so Billroth II gastrectomy and T-tube drainage were performed. She was then left with bile leakage from penrose drain whenever the T-tube was clamped. Endoscopic retrograde cholangiopancreatography (ERCP) revealed choledochoduodenocutaneous fistula. Nothing by mouth, total parenteral nutrition (TPN), biliary stent, endoscopic nasobiliary drainage catheter in afferent loop (A loop), and somatostatin infusion were given, and finally the biliary cutaneous fistula healed with the removal of T-tube and penrose drain.

並列關鍵字

biliary fistula ； choledochoduodenocutaneous fistula ； biliary stent