Abstract
Objective To summarize the experience in prevention and management of delayed-diagnosed injury in choledocho-pancreatico-duodenal junction. Methods The clinical data of 5 patients with injury in chole-docho-pancreatico-duodenal junction who had received surgery from 2000 to 2007 in Peking Union Hospital was summarized and analyzed retrospectively. All the 5 patients were diagnosed 24 hours after the injury. The injury was caused after endoscopic retrograde cholangiopancreatography (or endoscopic sphincterotomy) +endovascular stent placement in 4 patients and by vehicle accident in 1 patient. Results All the patients were treated conserva-tively for 24-72 hours, and peritonitis was not alleviated, and were subsequently transferred to surgery. Three patients received gastrostomy +choledochostomy +jejunostomy. The abdominal pain was alleviated in 1 patient, and 2 died of multiple organ dysfunction syndrome 5-6 weeks later. Two patients received duodenal diverticulariza-tion + gastrostomy + jejunostomy + Roux-en-Y choledachojejunostomy + Roux-en-Y gastrojejunostomy, and had good prognosis. Conclusion Duodenal diverticularization is a proper choice for patients with perforation combined with severe intraabdominal infection. Key words: Choledocho-pancreatico-duodenal junction; Injury; Delayed diagnosis; Treatment
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