Urakami Atsushi, Tsunoda Tsukasa, Kubozoe Tadahiko, Takeo Tomoyuki, Yamashita Kazuki, Imai Hiroyuki
Department of Gastroenterological Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki-shi, Okayama 701-0192, Japan.
J Hepatobiliary Pancreat Surg. 2002;9(3):383-5. doi: 10.1007/s005340200045.
A bleeding pancreatic pseudocyst following pancreatitis is a severe complication that can lead to massive gastrointestinal bleeding. Rupture of such a pseudocyst into the stomach is rare. We report herein a case of rupture of a bleeding pseudocyst into the stomach in a patient who was successfully treated with emergency surgery. A 60-year-old Japanese man with a history of chronic alcoholic pancreatitis with a pancreatic tail pseudocyst was referred to us because of hematemesis. The cavity of the pseudocyst, which was 3 cm in size and whose wall adhered to the stomach, was enhanced by dynamic bolus computed tomography (CT) in the late arterial phase. Splenic angiography revealed a bleeding pseudocyst in the splenic hilum. Embolization of the pseudocyst failed, because of arterial spasm. A distal pancreatectomy, splenectomy, and total gastrectomy were performed. The wall of the pseudocyst consisted of the pancreatic tail, granulation tissue, and the posterior wall of the stomach. The patient's postoperative course was uneventful. In the management of massive bleeding from a pseudocyst, early diagnosis with dynamic bolus CT and angiography is essential. A bleeding pseudocyst should be considered to be a lethal complication, but it can possibly be treated with a combination of angiographic embolization and surgery.
胰腺炎后出血性胰腺假性囊肿是一种严重并发症，可导致大量胃肠道出血。这种假性囊肿破入胃内的情况罕见。我们在此报告一例出血性假性囊肿破入胃内的病例，该患者经急诊手术成功治疗。一名60岁有慢性酒精性胰腺炎病史且伴有胰尾假性囊肿的日本男性因呕血被转诊至我院。大小为3 cm且囊壁与胃粘连的假性囊肿腔在动脉晚期通过动态团注计算机断层扫描（CT）显示强化。脾血管造影显示脾门处有一出血性假性囊肿。由于动脉痉挛，假性囊肿栓塞失败。遂行胰体尾切除术、脾切除术及全胃切除术。假性囊肿壁由胰尾、肉芽组织和胃后壁组成。患者术后恢复顺利。在处理假性囊肿大量出血时，动态团注CT和血管造影早期诊断至关重要。出血性假性囊肿应被视为一种致命并发症，但可能通过血管造影栓塞和手术联合治疗。
