經內視鏡囊腫胃造口吻合術造成引流管誤入胰臟偽囊腫內並經使用內視鏡取出引流管：病例報告

Endoscopic Cystogastrostomy Related Stent Migration into Pancreatic Pseudocyst to be Removed by Endoscopy: A Case Report

44歲的男性，因為持續一星期的腹脹及腹部不舒服而至本院求診。病人到院的2週前，曾因急性胰臟炎發作而至他院住院。常時的腹部電腦斷層掃瞄。顯示胰臟體部有一囊腫。入院後，腹部超音波看到一個大約10×8 cm的胰臟囊腫位於體部，並與胃壁緊密接觸。基於胰臟偽囊腫的診斷，我們為病人進行經內視鏡囊腫胃造口吻合術，並插入一支7 Fr引流管進行內引流。由於引流管阻塞併囊腫感染，數天後我們再次為病人進行經內視鏡囊腫胃造口吻合術，重新插入一支12 Fr的引流管。在插入的過程中，原來的7 Fr引流管意外地被推入囊腫內。10多天後，腹部超音波顯示胰臟偽囊腫己經變小。因此，我們先利用內視鏡拔除12 Fr的引流管，並使用Dormia氏取物籃經由內視鏡的工作通道，沿著原囊腫胃造口處，進入胰臟偽囊腫內；藉著X光透視的引導，經過1小時多的努力，才順利取出囊腫內的7 Fr引流管。術後第2天病患順利出院，經過8個月的追蹤，囊腫無復發情形，病人也沒有任何不適。

A 44-year-old man visited our hospital with complaints of abdominal fullness and discomfort for I week, though he had been admitted to another hospital because of an attack of acute pancreatitis about 2 weeks ago. At that time, abdominal computed tomography (CT) demonstrated a pancreatic cyst in the body. On admission, abdominal sonography revealed a 10 × 8 cm cyst located in the pancreas body and closely contacted with the gastric wall. Under the impression of pancreatic pseudocyst, endoscopic cystogastrostomy with a 7-Fr double pigtail stent for internal drainage was performed. Because of clogging of the stent and the infection of the pseudocyst, another cystogastrostomy with a 12-Fr stent was carried out several days later. The previous 7-Fr stent was accidentally pushed into the pseudocyst during the second procedure. Since the repeated abdominal sonography demonstrated a small residual pancreatic pseudocyst 10 more days later, the 12-Fr stent was removed endoscopically, followed by an insertion of a Dormia basket into the residual cyst from the cystogastrostomy entrance, through the endoscopic working channel. We tried to grasp the floating stent under the guidance of fluoroscopy and the stent was successfully retrieved I hour later. The patient was discharged the next day. He no longer suffered from abdominal discomfort, and there was no evidence of recurrence of pancreatic pseudocyst by imaging studies throughout the following 8 mons of OPD follow-up.