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Endoscopic sphincterotomy an emergency intervention in obstructive common bile duct diseases

Endoscopic sphincterotomy an emergency intervention in obstructive common bile duct diseases

Intensivmedizin 18(4): 242-248

Emergency endoscopic sphincterotomy was successfully performed in 69 patients suffering from obstructive biliary diseases. In 63 patients the obstructive jaundice was caused by choledocholithiasis. Fifteen of these patient showed an acute biliary type pancreatitis. In 5 patients the cause of the obstruction was a carcinoma. In 1 case endoscopic retrograde cholangiography revealed a benign stricture of the papilla of Vater. All cases were high risk patients. These patients were all of advanced age and had the typical complications of the gallstone disease. Many of them had 2nd diseases or previous operations on the gastrointestinal tract. Thirty men and 39 women were treated. The average age was 71 yr. Following endoscopic sphincterotomy a rapid improvement of the clinical symptoms was found. The pathological laboratory findings normalized within a few days. In 5 patients there were complications (7.2%). One patient developed a retroperitoneal abscess and 1 patient immediately showed severe arterial bleeding after endoscopic sphincterotomy. Both patients were operated on. In 2 cases there was mild hemorrhaging which was treated with blood transfusions. One patient died of a liver abscess. So the mortality rate was 1.4%. Endoscopic sphincterotomy is apparently an impressive alternative to early surgery in emergency cases of obstructive biliary disease in the aged and high risk patient.

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Accession: 005359596

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