BACKGROUND/AIMS: Diagnostic or thepapeutic endoscopic retrograde cholangiopancreatography (ERCP) is the mainstream for the pancreaticobiliary disease. However, the ERCP related complications are serious and sometimes fatal to the patients. We have reviewed our experiences of the operative management for the ERCP injury. METHODS: Medical records of 13 patients who underwent laparotomic surgical intervention for various ERCP injuries from March 1996 to August 2002 at Department of Surgery, the Catholic University of Korea were reviewed. RESULTS: The age range of the patients was from 28 to 85 years. There were 5 females and 8 males. 6 patients showed the duodenal perforations and 4 patients suffered from bleedings around the ampulla of Vater. One of the 4 bleeding patients had huge expanding submucosal hematomas throughout the entire duodenum. We found massive retroperitoneal extraluminal air density in one patient but we could not find any leakage of the contrast media during the upper gastrointestinal series, however, this patient complained aggravated peritoneal irritation sign, so we explored the abdomen. Most of the patients had free abdominal or retroperitoneal air shadows (n=7) on plain chest or abdominal X-ray. We diagnosed the uncontrolled bleeding from the sphincterotomy site using the gastroduodenal fiberscopes in 3 patients. On the computed tomogaphic images, one patient showed a huge duodenal hematoma, another one had a retroperitoneal fluid collection and another one revealed a retroperitoneal air shadow. One patient showed aggravated pancreatitis on the serial CT scan and finally the patient developed a hemorrhagic necrotizing pancreatitis, then we explored the abdomen and tried peripancreatic drainage but we lost the patient in 19 postoperative day due to sepsis. The other 12 patients survived by the various surgical procedures. For the 6 patients, we performed duodenotomic sphincteroplasty, tube duodenostomy and biliary drainage with T-tube. One patient survived with Whipple's procedure, one patient improved by the pyloric exclusion and one patient cured with the duodenal diverticulization. Other procedures were primary repair of the duodenum, transduodenal sphincteroplasty and just cholecystectomy and T-tube choledochostomy. CONCLUSION: There was tendency to uneventful improvement of patients by the early detection and urgent laparotomic surgical intervention of the ERCP complication.
Abdomen ; Ampulla of Vater ; Cholangiopancreatography, Endoscopic Retrograde* ; Cholecystectomy ; Choledochostomy ; Contrast Media ; Drainage ; Duodenostomy ; Duodenum ; Female ; Hematoma ; Hemorrhage ; Humans ; Korea ; Male ; Medical Records ; Pancreatitis ; Sepsis ; Sphincterotomy, Transhepatic ; Thorax ; Tomography, X-Ray Computed

To study the effect of one part of hemodynamic changes following spinal aneethesia on the time-dependent change of aterial oxygen saturation (SaO2) from the upper extremities and lower extremities, we analyzed the ASA class I, 30 patients (Group I, Tetracaine only (n =15), 40+/-6 years, 58+/-7kg, 162+/-6cm, Group II, Tetracaine+/-Epinephrine (n=15), 41+/-6 years, 59+/-6kg, 161+/-7cm) scheduled for urologic surgery under lower spinal anesthesia. The results were as follows: 1) There was no significant difference of preanesthetic SaO2 between upper and lower extremities in two groups (p>0.05). 2) There was no significant diference of time-dependent changes of postanesthetic SaO, in the upper extremities as compared with preanesthetic value (p=0.05). 3) There was significant ifference of time-dependent changes of postanesthetic SaO2, at 5 min, 10 min and 15 min in the lower extremities of Group I, on the other hand, at 10 min and 15 min in Group II as compared with control value (p<0.05). 4) There was significant difference of postanesthetic SaO at 10 min and 15 min in the lower extremities between two groups (p<0.05). 5) It took more longer to reach the maximum level of SaO2, after inal anesthesia in Group II as compared with Group I (p<0.05).
Anesthesia ; Anesthesia, Spinal ; Hand ; Hemodynamics ; Humans ; Lower Extremity* ; Oxygen* ; Tetracaine ; Upper Extremity*