Janowitz P, Von Moltke A, Weidmann B
Klinik für Innere Medizin, Krankenhaus Burg, Germany.
Dtsch Med Wochenschr. 2002 Dec 13;127(50):2669-72. doi: 10.1055/s-2002-36113.
We report three male patients who had atrial fibrillation with a rapid and irregular ventricular rate, aged 60, 69 and 70 years, respectively, in whom development of acute pancreatitis occurred simultaneously with other ischaemic events.
One of these patients simultaneously suffered from a transient ischaemic attack (TIA), another developed a stroke and an infarction of the spleen, while the third one had a splenic infarction and an embolism in the region of the mesenteric arteries. Two patients had paroxysmal atrial fibrillation, while the third suffered from ischemic cardiomyopathy with chronic atrial fibrillation.
Oedematous pancreatitis occurred in one patient while, in the two others, the diagnosis of severe necrotizing pancreatitis was made.
Atrial fibrillation is the most common sustained arrhythmia encountered in clinical practice and a recognized risk factor for the development of peripheral embolism, which often takes the form of an ischaemic stroke. It is a major cause of stroke, especially in the elderly. Because of the simultaneous occurrence of thromboembolic events in all three patients, an ischaemic cause for the acute pancreatitis can be assumed with a high degree of probability. This is one of the first reports of acute ischaemic pancreatitis probably caused by microembolization secondary to atrial fibrillation. Because of the relatively frequent occurrence of atrial fibrillation, this factor deserves increased attention in the differential diagnosis of supposedly idiopathic pancreatitis.
我们报告了三名男性患者，年龄分别为60岁、69岁和70岁，均患有快速且不规则心室率的心房颤动，他们在发生急性胰腺炎的同时还出现了其他缺血性事件。
其中一名患者同时患有短暂性脑缺血发作（TIA），另一名患者发生了中风和脾梗死，而第三名患者有脾梗死和肠系膜动脉区域的栓塞。两名患者为阵发性心房颤动，第三名患者患有缺血性心肌病伴慢性心房颤动。
一名患者发生了水肿性胰腺炎，另外两名患者被诊断为严重坏死性胰腺炎。
心房颤动是临床实践中最常见的持续性心律失常，也是公认的外周栓塞发生的危险因素外周栓塞，外周栓塞常表现为缺血性中风。它是中风的主要原因，尤其是在老年人中。由于所有三名患者均同时发生血栓栓塞事件，因此高度怀疑急性胰腺炎的病因是缺血性的。这是首批关于可能由心房颤动继发微栓塞引起的急性缺血性胰腺炎的报告之一。由于心房颤动相对常见，在疑似特发性胰腺炎的鉴别诊断中，这一因素应得到更多关注。
