Zusammenfassung
Benigne Stenosen der ableitenden Gallenwege haben verschiedene Ursachen und sind ätiologisch von Ableitungsstörungen zu unterscheiden, die durch maligne Tumorerkrankungen verursacht werden. Die Therapie dieser gutartigen Stenosen ist mitunter schwierig und umfasst endoskopische, perkutane und chirurgische Interventionen. Für eine erfolgreiche Behandlung und Auswahl der besten Methode ist eine genaue Kenntnis von Ursache und Lokalisation der vorliegenden Striktur notwendig.
Wir präsentieren den Fall eines 71-jährigen Patienten, der sich 13 Jahre nach einer Radiato des rechten Nierenbetts erstmals mit klinischen und laborchemischen Zeichen einer Cholangitis in unserer Klinik vorstellte und bei dem die seltene Diagnose einer radiogen bedingten extrahepatischen Gallengangstenose gestellt werden konnte. Anhand des Fallberichts, der einen Behandlungszeitraum von insgesamt 15 Jahren umfasst, diskutieren wir eine sinnvolle Abfolge von Behandlungsmöglichkeiten bei benignen Gallenwegstenosen.
Abstract
Benign biliary stenosis can have various causes and requires differentiation from disorders caused by malignant disease. Treatment of benign stenosis is often difficult and includes treatment modalities such as endoscopic, percutaneous or surgical interventions. Exact knowledge of the etiology and localization of the stenosis is essential when selecting the appropriate method of treatment.
Here we present the case of a 71-year-old patient admitted to our hospital with cholangitis 13 years after undergoing radiotherapy of the renal bed due to hypernephroma of the right kidney. The patient was diagnosed with common bile duct stenosis due to the secondary effects of radiation, which is rarely reported in the literature. Our case covers a total treatment period of 15 years, enabling us to also discuss a viable sequence of treatment modalities in the treatment of benign bile duct stenosis.
Literatur
Smith MT, Sherman S, Lehman GA (1995) Endoscopic management of benign strictures of the biliary tree. Endoscopy 27:253–266
Weber A, Feussner H, Winkelmann F et al (2009) Long-term outcome of endoscopic therapy in patients with bile duct injury after cholecystectomy. J Gastroenterol Hepatol 24:762–769
Siewert JR, Feussner H, Scherer MA, Brune IB (1993) Fehler und Gefahren der laparoskopischen Cholecystektomie. Chirurg 64:221–229
Weber A, Prinz C, Gerngroß C et al (2009) Long-term outcome of endoscopic and/or percutaneous transhepatic therapy in patients with biliary stricture after orthotopic liver transplantation. J Gastroenterol 44:1195–1202
Wislooff F, Jakobsen J, Osnes N (1982) Stenosis of the common bile duct in chronic pancreatitis. Br J Surg 69:52–54
Wehbe S (1978) Duodenal stenosis following irradiation of the kidneys for tumours. A report of four cases. Rofo 129:421–424
Lévy P, Menzelxhiu A, Paillot B et al (1993) Abdominal radiotherapy is a cause for chronic pancreatitis. Gastroenterology 105:905–909
Gorea G, Demy M, Tran Van Nhieu J et al (2010) Radiation-induced cholangitis with hepatocellular carcinoma. Gastroenterol Clin Biol 34:35–39
Bergman JJ, Burgemeister L, Bruno MJ et al (2001) Long-term follow-up after biliary stent placement for postoperative bile duct stenosis. Gastrointest Endosc 54:154–161
Born P, Rösch T, Brühl K et al (1999) Long-term results of endoscopic and percutaneous transhepatic treatment of benign biliary strictures. Endoscopy 31:725–731
Born P, Neuhaus H, Rösch T et al (1996) A minimally invasive palliative approach to advanced pancreatic and papillary cancer causing both biliary and duodenal obstruction. Z Gastroenterol 34:416–420
Dumonceau JM, Devière J, Delhaye M et al (1998) Plastic and metal stents for postoperative benign bile duct strictures: the best and the worst. Gastrointest Endosc 47:8–17
Costamagna G, Pandolfi M, Mutignani M et al (2001) Long-term results of endoscopic management of postoperative bile duct strictures with increasing numbers of stents. Gastrointest Endosc 54:162–168
Draganov P, Hoffman B, Marsh W et al (2002) Long-term outcome in patients with benign biliary strictures treated endoscopically with multiple stents. Gastrointest Endosc 55:680–686
Pitt HA, Kaufman SL, Coleman J et al (1989) Benign postoperative biliary strictures. Operate or dilate? Ann Surg 210:417–425
Berkelhammer C, Kortan P, Haber GB (1989) Endoscopic biliary prostheses as treatment for benign postoperative bile duct strictures. Gastrointest Endosc 35:95–101
Huibregtse K, Katon RM, Tytgat GN (1986) Endoscopic treatment of postoperative biliary strictures. Endoscopy 18:133–137
Davids PH, Rauws EA, Coene PP et al (1992) Endoscopic stenting for post-operative biliary strictures. Gastrointest Endosc 38:12–18
Geenen DJ, Geenen JE, Hogan WJ et al (1989) Endoscopic therapy for benign bile duct strictures. Gastrointest Endosc 35:367–371
Kose F, Oguzkurt L, Besen A et al (2011) Effectiveness of percutaneous metal stent placement in cholangiocarcinoma patients with midterm follow-up: single center experience. Eur J Radiol (im Druck). DOI 10.1016/j.ejrad.2011.04.056
Bakhru MR, Kahaleh M (2011) Expandable metal stents for benign biliary disease. Gastrointest Endosc Clin N Am 21:447–462
Will U, Müller A, Wanzar I et al (2011) EUS-guided drainage – indications and technical approach. Endo Heute 24:33–50
Tessier G, Bories E, Arvanitakis M et al (2007) EUS-guided pancreatogastrostomy and pancreatobulbostomy for the treatment of pain in patients with pancreatic ductal dilatation inaccessible for transpapillary endoscopic therapy. Gastrointest Endosc 65:233–241
Mallery S, Matlock J, Freeman ML (2004) EUS-guided rendezvous drainage of obstructed biliary and pancreatic ducts: Report of 6 cases. Gastrointest Endosc 59:100–107
Kahaleh M, Hernandez AJ, Tokar J et al (2006) Interventional EUS-guided cholangiography: evaluation of a technique in evolution. Gastrointest Endosc 64:52–59
(o A) (2003) Roche Lexikon Medizin, 5. Aufl. Elsevier GmbH, Urban & Fischer, München
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Klare, P., Weber, A., Dobritz, M. et al. Endoskopische und perkutane Interventionen in der Langzeitbehandlung benigner Gallengangstenosen. Internist 53, 874–881 (2012). https://doi.org/10.1007/s00108-012-3053-2
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DOI: https://doi.org/10.1007/s00108-012-3053-2