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◆要旨:患者は64歳,男性.自己免疫性膵炎による閉塞性黄疸に対して内視鏡的逆行性胆道ドレナージ術(ERBD)を施行した.3か月後に腹痛が出現し,症状は数日で改善したが,1か月後の腹部CTでERBDステントの不完全逸脱と十二指腸穿通を認めたため,腹腔鏡手術を施行した.腹腔鏡下結腸右半切除術の後腹膜アプローチに準じて結腸間膜と後腹膜を剝離して十二指腸部穿通部に到達した.穿通部は後腹膜内でステントに沿って瘻孔を形成しており,ステント抜去したのちに瘻孔の閉鎖を行った.ERBDステントの不完全逸脱による十二指腸穿通に対して腹腔鏡下でのステント抜去術と閉鎖術を施行した稀な症例であり報告する.
A 64-year-old male patient underwent endoscopic retrograde biliary drainage (ERBD) for obstructive jaundice due to autoimmune pancreatitis. Abdominal pain appeared 3 months later, but the symptom improved within a few days. However, one month later, an abdominal computed tomography scan revealed a deviation of the ERBD stent and duodenal perforation; therefore, laparoscopic surgery was performed. The space between the mesentery and retroperitoneum was dissected via the retroperitoneal approach using laparoscopic right hemicolectomy to reach the perforated duodenum. The perforated part formed a fistula, which was sutured after removal of the stent. Thus, we report a rare case of laparoscopic stent removal and fistula plication for a duodenal perforation due to ERBD stent deviation.
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