Two cases of splenic injury - one after a difficult colonoscopy and the other after routine ERCP - are reported. Splenic injury as a complication of endoscopic procedures is relatively rare, but over the past several years this complication has been increasingly reported. Review of the literature revealed 11 cases occurring after colonoscopy and one after ERCP. Although most of the patients presented with acute abdominal symptoms, some had mild vague symptoms. In two cases the injury was overlooked entirely. Diagnosis was established at laparotomy in four cases, by CT in four, by ultrasonography in two, by chance observation in two, by angiography in one and by paracentesis in one. All patients except the most recent three reported underwent surgery, with one mortality occurring three weeks after the operation.
The present study is the largest study showing complication and recurrence rates after colorectal polypectomy of advanced colorectal adenomas of ≥3 cm in size. Polyp size was identified as the most important risk factor for complications. For the first time, this study shows that the complication rate after colorectal polypectomy of large adenomas is correlated inversely with the residual and/or recurrence rate.
Die Cholangiolithiasis wurde früher ausschlieβlich chirurgisch behandelt. Die klassische Operation ist heute durch die endoskopisch retrograde Therapie und die perkutan-transhepatische Steinbehandlung weitgehend abgelöst worden. Die Ursache dafür ist das wesentlich geringere Risiko der «alternativen» Techniken. Optimale Ergebnisse resultieren aus einer Differentialtherapie, bei der alle Techniken in enger Absprache zwischen den intervenierenden Chirurgen, Endoskopikern oder Radiologen dem jeweiligen Einzelfall angemessen zum Einsatz kommen.
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