총담관결석증 환자에서 침형절개도 누공형성술 후 유도선을 이용한 담도 삽관 과정 중 발생한 간문맥 내 삽관 1예

• Published in: The Korean journal of gastroenterology Vol. 77; no. 5; pp. 253 - 257
• Main Authors: 이원동, Won Dong Lee, 송재선, Jae Sun Song, 김병선, Byung Sun Kim, 양민아, Min A Yang, 이영재, Young Jae Lee, 정금모, Gum Mo Jung, 조용근, Yong Keun Cho, 조진웅, Jin Woong Cho, 김지웅, Ji Woong Kim
• Format: Journal Article
• Language: Korean
• Published: 대한소화기학회 31.05.2021
• Subjects: Catheterization; Cholangiopancreatography; Choledocholithiasis; endoscopic retrograde; Portal vein; 내과학
• ISSN: 1598-9992; 2233-6869
• DOI: 10.4166/kjg.2021.030

Cannulation of the portal vein is a rare complication of ERCP. This paper reports a case of portal vein catheterization during ERCP in a patient with choledocholithiasis. A 62-year-old man was admitted to the Presbyterian Medical Center with right upper quadrant pain and jaundice. ERCP was performed under the suspicion of obstructive jaundice caused by a radiolucent stone. Bile duct cannulation using a pull-type papillotome was attempted, but it failed. After needle-knife fistulotomy, wire-guided cannulation was performed successfully, and 10 mL contrast was injected. On the other hand, the fluoroscopy image showed that the contrast medium disappeared very quickly. Pure blood was collected when the catheter was aspirated to identify the bile reflux, indicating possible cannulation of the portal vein. The procedure was terminated immediately and abdominal computed tomography showed air in the portal vein. One day after, a follow-up CT scan showed no air in the portal vein. The patient underwent repeated ERCP, and the common bile duct was cannulated. In most cases, isolated portal vein cannulation does not result in severe morbidity. However, it is important to aware of this rare complication so that no further invasive procedure is performed on the patient. (Korean J Gastroenterol 2021;77:253-257)