Zusammenfassung
Wir berichten von einer 52-jährigen Patientin, bei der aufgrund einer Choledocholithiasis eine endoskopische Sphinkterotomie der Papille durchgeführt wurde, in deren Folge es zu einer Milzruptur kam. Die klinische Symptomatik bestand in einem hämorrhagischen Schock, die Diagnose konnte mittels CT und sonographisch gestützter Parazentese gestellt werden. Therapeutisch wurde eine Notfall-Splenektomie durchgeführt.
Die Kasuistik, insbesondere die Mechanismen, die zu einer Milzruptur führen können, wird anhand einer Literaturübersicht diskutiert.
Die Kasuistik unterstreicht die Notwendigkeit, auch mit einer solch seltenen Komplikation der ERCP zu rechnen.
Abstract
We report on a 52 year old woman, who developed splenic rupture after endoscopic sphincterotomy for multiple biliary stones. After hemorrhagic shock had developed, the diagnosis was established by computed tomography and ultrasound guided paracentesis. The patient was treated by emergency splenectomy. The case report stresses the necessity to be aware of splenic rupture as a rare complication after ERCP. A review of the current literature regarding splenic rupture is provided and mechanisms of splenic trauma and risk factors are discussed.
Schlüsselwörter
Milz - Milzruptur - ERCP - Komplikationen der ERCP
Keywords
Spleen - splenic rupture - adverse effects of ERCP - ERCP
Literatur
-
1
McCune W S, Shorb P E, Moscowitz H.
Endoscopic cannulation of the ampulla of Vater: A preliminary report.
Ann. Surg.
1968;
167
752
-
2
Classen M, Demling L.
Endoskopische Sphinkterotomie der Papilla Vateri und Steinextraktion aus dem Ductus choledochus.
Dtsch Med Wochenschr.
1974;
99
496-497
-
3
Kawai K, Akasaka Y, Murakami K. et al .
Endoscopic spincterotomy of the ampulla of Vater.
Gastrointest Endosc.
1974;
20
148-151
-
4
Cotton P B, Lehmann G, Vennes J A. et al .
Endoscopic spincterotomy, comlications and therir management: an attempt at consensus.
Gastrointest Endosc.
1991;
37
383-393
-
5
Freeman M L, Nelson B D, Sherman S.
Complications of endoscopic biliary sphincterotomy.
NEJM.
1996;
335
909-918
-
6
Cohen S A, Siegel J H, Kasmin F E.
Complications of diagnostic and therapeutic ERCP.
Abdom Imaging.
1996;
21
385-394
-
7
Trondsen E, Posseland A R, Moer A. et al .
Rupture of the spleen following endoscopic retrograde cholangiopancreatography (ERCP), case report.
Acta Chir Scand.
1989;
155 (1)
75-76
-
8
Lo A Y, Washington M, Fischer M G.
Splenic trauma following endoscopic retrograde cholangiopancreatography (ERCP).
Surg Endosc.
1994;
8 (6)
692-693
-
9
Becker C D, Mentha G, Terrier F.
Blunt abdominal trauma in adults: role of CT in the diagnosis and management of visceral injuries.
Eur Radiol.
1998;
8 (4)
553-562
-
10
Ong E, Bohmler U, Wurbs D.
Splenic injury as a complication of endoscopy: two case reports and a literature review.
Endoscopy.
1991;
23 (5)
302-304
-
11
Furman G, Morgenstern L.
Splenic injury and abscess complicating endoscopic retrograde cholangiopancreatography (ERCP).
urg Endosc.
1993;
7 (4)
343-344
-
12
Lewis F W, Moloo N, Stiegmann G V. et al .
Splenic injury complicating therapeutic upper gastrointestinal endoscopy and ERCP.
Gastrointest Endosc.
1991;
37 (6)
632-33
-
13
Slauterbeck J R, Hardy D M.
Sex hormones and knee ligament injuries in female athletes.
Am J Med Sci.
2001;
322 (4)
196-199
-
14
Sciore P, Frank C B, Hart D A.
Identification of sex hormone receptors in human and rabbit ligaments of the knee by reverse transcription-PCR.
J Orthop Res.
1998;
16
604-610
-
15
Karageanes S J, Blackburn K, Vangelos Z A.
The association of the menstrual cycle with the laxity of the anterior cruciate ligament in adolescent female athletes.
Clin J Sport Med.
2000;
10
162-168
-
16
Wojtys E M, Huston L J, Boyton M D. et al .
The effect of menstrual cycle on anterior cruciate ligament injuries in women determined by hormone levels.
Am J Sports Med.
2002;
30
182-188
-
17
Wu W C, Katon R M.
Injury to the liver and spleen after diagnostic ERCP.
Gastrointest Endosc.
1993;
39 (6)
824-827
-
18
Moreaux J, Bismuth H.
Les complications splenic des pancréatitides chroniques, 5 observations.
Presse Med.
69;
77
1467-1470
-
19
Wilkinson A E.
Rupture of the spleen. An analysis of 421 cases.
S. Afr. J. Surg.
1989;
27
74-75
-
20
Vas W, Friend W D.
Rupture of a normal spleen caused by vomiting following a metrizamide myelogramm.
Diagn Imaging.
1981;
50
309-312
Tillman Deist
Innere Klinik II, Kreiskrankenhaus Aschersleben-Staßfurt. Standort Aschersleben
Eislebener Str. 7a
06449 Aschersleben
eMail: t.deist@kkl-as.de
