Komplike Karaciğer Kist Hidatiği Sebebiyle Parsiyel Kistektomi ve Omentopeksi Yapılmış Hastada Postoperatif Gelişen Yüksek Debili Safra Fistülünün Minimal İnvaziv Girişimsel ve Endoskopik Yöntemlerle Tedavisi
Özet
Serolojik ve klinik aktif, komplike, çapı yaklaşık >10 cm Cystic Echinococcus Gharbi Tip 3 (CE 3B) karaciğer kist hidatik tanısı ile kliniğimize başvuran, medikal tedavi almakta olan 50 yaşında kadın hastada ileri tetkik ve tedavi planlandı. PAİR (Puncture, Aspiration, İnjection, Reaspiration) sonrası safra fistülü tespit edilen, fistül yönetimi, MoCat (Modified Catheterization technique) + ERCP – Endoskopik sfinkterotomiye eklenen biliyer stent şeklinde seçilen hastada safra fistülü sebat etmesi üzerine cerrahi kararı alındı. Açık cerrahi metodla opere edilen hastaya parsiyel kistektomi yapıldı. Vaka boyunca kaviteden safra kaçağı gözlenmedi. Omentopeksi ve drenaj eklenerek vaka sonlandırıldı. Postoperatif erken dönemde yüksek debili (> 500 cc) safra fistülü devam eden hastaya önce ERCP ile selektif kateterizasyon ve ardından PTK ile eksternal drenaj uygulandı. Omentopeksi ve cerrahi drenaj ile birlikte postoperatif dönemde uygulanan minimal invaziv girişimsel ve endoskopik metodlarla yakalşık 4 hafta içinde fistül kontrol altına alındı. Komplike karaciğer kist hidatiklerinde tüm tedavi sürecinde cerrahiye eşlik eden minimal invaziv girişimsel ve endoskopik metodları hasta ve literatür eşliğinde tartıştık.
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