Core Viewpoint - The article highlights a successful emergency medical intervention for an 80-year-old patient suffering from acute cholangitis, showcasing the collaboration between ICU and gastroenterology teams in a challenging situation without the use of X-ray guidance [1][2][3][4]. Group 1: Patient Condition and Diagnosis - The patient, referred to as Zhang, was diagnosed with "multiple stones in the common bile duct combined with acute suppurative cholangitis," leading to severe complications including infection and acute renal failure [2]. - Despite aggressive antibiotic treatment, the patient's condition did not improve, necessitating urgent intervention to relieve the blockage in the bile duct [2]. Group 2: Emergency Response and Treatment Approach - Due to the patient's age and critical condition, a standard transfer to the endoscopy center was deemed too risky; thus, a decision was made to perform a bedside ERCP without X-ray guidance [2][3]. - The medical team, led by Dr. Ma and supported by Nurse Zhao, quickly mobilized to the ICU with the necessary equipment to perform the procedure [2]. Group 3: Surgical Procedure and Challenges - The surgery commenced under strict monitoring, relying solely on the medical team's experience and coordination, as there was no X-ray equipment available [3]. - Significant challenges included the patient's pylorus being in spasm and anatomical variations that complicated access to the bile duct, requiring multiple attempts and adjustments during the procedure [4]. Group 4: Outcome and Recovery - The procedure successfully re-established the bile duct's patency by placing a stent, which allowed for effective drainage and control of the infection [4]. - Following the intervention, the patient showed signs of recovery, including the removal of the ventilator support, indicating a positive outcome from the critical care provided [4].

经过诊断，明确张奶奶为"胆总管多发结石合并急性化脓性胆管炎"。这是一种极为凶险的外科急症，大 量细菌和毒素淤积在胆管内，随胆汁进入血液循环，足以在短时间内夺去生命。尽管给予强力抗感染治 疗，但病情未能得到有效控制。复查CT再次证实，胆总管下段被多发结石牢牢堵塞。引流淤积已化脓 的胆汁，成为控制感染、挽救生命的突破口。面对这种情况，常规的治疗路径是尽快将患者转运至内镜 中心（广州路院区），进行标准的X射线下ERCP手术。但考虑到张奶奶高龄、虚弱，全靠呼吸机辅助 呼吸，承受不起转运的颠簸和风险。 ERCP，全名叫"经内镜逆行胰胆管造影手术"，被称为"胆胰管道工"，是一种非常精细且复杂的微创手 术。通过从患者口腔里插进一根细细的十二指肠镜，不用开腹，ERCP创伤小、恢复快，适应症涵盖胆 总管结石、胰管狭窄等。如果要在无X线引导下完成"盲视"操作，则需要医者对解剖结构有极高的精准 感知。 转自：扬子晚报 近日，江苏省人民医院（南京医科大学第一附属医院、江苏省妇幼保健院）龙江院区收治了一位80岁的 危重患者——张奶奶（化名）因腹部剧痛被家人送至医院，确诊为死亡率极高的急性胆道重症。龙江院 区ICU团队与消化内科团队凭借 ...