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Astuce pour cathétériser une « papille invisible » intradiverticulaire

Manoeuvre for catheterisation of an intra-diverticular “invisible papilla”

  • Cas Clinique / Case Report
  • Published:
Acta Endoscopica

Résumé

Un patient de 83 ans était hospitalisé quelques jours après une cholécystectomie pour suspicion de calculs de la voie biliaire principale (VBP). Les examens complémentaires et la bili-IRM révèlent une voie biliaire large, sans obstacle visible. L’échoendoscopie réalisée juste avant la cholangiopancréatographie rétrograde endoscopique (CPRE) note la présence de plusieurs calculs infracentimétriques intracholédociens. En duodénoscopie, on se positionne en position courte en face d’un volumineux diverticule duodénal mais dans lequel la papille n’est pas visualisable. La papille est exposée après avoir tracté la muqueuse duodénale paradiverticulaire à l’aide d’une pince à biopsie pédiatrique. La VBP est cathétérisée à l’aide d’un cathéter sur fil guide introduit dans le canal opérateur en parallèle de la pince à biopsie tractant la muqueuse. Une sphinctéroclasie à 10 mm permet d’extraire les calculs du cholédoque et d’assurer une vidange complète de la VBP.

Abstract

An 83-year-old man was admitted to hospital with suspected calculi in the common bile duct (CBD) a few days after cholecystectomy. Additional investigation including MRI of the biliary system showed widening of the biliary tract with no visible obstruction. Endoscopic ultrasound performed just prior to endoscopic retrograde cholangiopancreatography (ERCP) demonstrated the presence of several biliary duct stones of less than a centimeter in diameter. On duodenoscopy, in the short scope position, we noticed a large duodenal diverticulum, within which the papilla could not be seen. A paediatric biopsy forceps was used to apply traction to the para-diverticular duodenal mucosa and the papilla was then revealed. The common bile duct (CBD) was cannulated by a catheter mounted on a guide wire inserted into the operating channel in parallel with the biopsy forceps, which maintained traction on the mucosa. A 10 mm sphincteroplasty facilitated the extraction of the bile duct stones and ensured that the CBD was evacuated completely.

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Authors and Affiliations

  1. Pôle digestif Paris Bercy (PDPB), clinique de Bercy, 9, quai de Bercy, F-94220, Charenton-le-Pont, France

    D. Karsenti & M. Kardache

  2. Service de chirurgie viscérale, hôpital de Meaux, 35, rue Saint-Fiacre, F-77100, Meaux, France

    B. Cherciu & M. Kabbej

Authors
  1. D. Karsenti
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  2. B. Cherciu
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  3. M. Kardache
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  4. M. Kabbej
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Correspondence to D. Karsenti.

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Karsenti, D., Cherciu, B., Kardache, M. et al. Astuce pour cathétériser une « papille invisible » intradiverticulaire. Acta Endosc 41, 23–25 (2011). https://doi.org/10.1007/s10190-011-0141-4

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  • DOI: https://doi.org/10.1007/s10190-011-0141-4

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