clinendoКлиническая эндоскопияFilin’s Clinical endoscopy2415-7813"Global Media technology" Ltdclinendo-608Research ArticleКЛИНИЧЕСКИЕ НАБЛЮДЕНИЯCLINICAL OBSERVATIONSСЛУЧАЙ ЭНДОСКОПИЧЕСКОЙ ДИАГНОСТИКИ И МНОГОЭТАПНОГО ЭНДОСКОПИЧЕСКОГО ЛЕЧЕНИЯ МЕХАНИЧЕСКОЙ ЖЕЛТУХИ У КОМОРБИДНОГО ПАЦИЕНТАA CASE OF ENDOSCOPIC DIAGNOSTICS AND MULTISTAGE ENDOSCOPIC TREATMENT OF OBSTRUCTIVE JAUNDICE IN A COMORBID PATIENTСолоницынЕ. Г.SolonitsynE. G.noemail@neicon.ruБогдановаВ. Л.BogdanovaV. L.noemail@neicon.ruДаниловИ. Н.DanilovI. N.noemail@neicon.ruУховаМ. В.UkhovaM. V.noemail@neicon.ruИванихаЕ. В.IvanikhaE. V.noemail@neicon.ruПоддымоваА. В.PoddymovaA. V.noemail@neicon.ruНеймаркА. Е.NeymarkA. E.noemail@neicon.ruФедеральное государственное бюджетное учреждение «Национальный медицинский исследовательский центр имени В. А. Алмазова» Министерства здравоохранения Российской ФедерацииAlmazov National Medical Research Centre20200912202542127Copyright © Солоницын Е.Г., Богданова В.Л., Данилов И.Н., Ухова М.В., Иваниха Е.В., Поддымова А.В., Неймарк А.Е., 20252025Солоницын Е.Г., Богданова В.Л., Данилов И.Н., Ухова М.В., Иваниха Е.В., Поддымова А.В., Неймарк А.Е.Solonitsyn E.G., Bogdanova V.L., Danilov I.N., Ukhova M.V., Ivanikha E.V., Poddymova A.V., Neymark A.E.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://clinendo.elpub.ru/jour/article/view/608

Мы представляем клинический случай морфологической диагностики и многоэтапного эндоскопического лечения механической желтухи у пациента с сочетанием Болезни Крона, первичного склерозирующего холангита и колоректальной аденокарциномы T4N2M0. Пациент поступил с клиникой механической желтухи. При дообследовании было диагностировано образование холедоха. Дифференциальный диагноз проводился между первичной холангиокарциномой и вторичным метастатическим поражением ворот печени с инвазией в холедох. Данные визуальных методов исследования (магнитно-резонансной томографии, эндоскопической ультрасонографии, компьютерная томография) не позволяли поставить окончательный диагноз поражения желчных протоков и печени. Решающее значение имело гистологическое исследование материала, полученного при тонкоигольной аспирационной пункции под контролем эндоскопической ультрасонографии и при щипцовой биопсии во время эндоскопической ретроградной холангиопанкреатографии. Лечение механической желтухи было осложнено наличием сочетанного механизма поражения желчных протоков (наличие новообразования холедоха и первичного склерозирующего холангита).

We present a clinical case of morphological diagnosis and multistage endoscopic treatment of obstructive jaundice in a patient with a combination of Crohn’s disease, primary sclerosing cholangitis, and colorectal adenocarcinoma T4N2M0. The patient was admitted to the clinic for obstructive jaundice. Upon further examination, the formation of a common bile duct was diagnosed. Differential diagnosis was made between primary cholangiocarcinoma and secondary metastatic lesion of the hepatic hilum with invasion of the common bile duct. The data of visual research methods (magnetic resonance imaging, endoscopic ultrasonography, computed tomography) didn’t make it possible to make a definitive diagnosis of damage to the bile ducts and liver. The histological examination of the material obtained by fine-needle aspiration puncture under the control of endoscopic ultrasonography and by forceps biopsy during endoscopic retrograde cholangiopancreatography was of decisive importance. The treatment of obstructive jaundice was complicated by the presence of a combined mechanism of damage to the bile ducts (the presence of neoplasm of the common bile duct and primary sclerosing cholangitis).

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The authors declare that there are no conflicts of interest present.