Skipworth J, Raptis D, Brennand D, Imber C, Shankar A
Department of Hepatobiliary and Pancreatic Surgery, University College Hospital NHS Trust, London, UK.
Ann R Coll Surg Engl. 2009 Apr;91(3):255-8. doi: 10.1308/003588409X359295. Epub 2009 Feb 13.
We present the case of a 45-year-old man, who presented to his local casualty department with severe epigastric pain following an alcohol binge, and was subsequently diagnosed with acute pancreatitis. Pancreatic necrosis with multiple collections ensued, necessitating transfer to an intensive care unit (ITU) in a tertiary hepatopancreaticobiliary centre. Initially, the patient appeared to slowly improve and was discharged to the ward, albeit following a prolonged ITU admission. However, during his subsequent recovery, he suffered multiple episodes of haematemesis and melaena associated with haemodynamic instability and requiring repeat admission to the ITU. Computerised tomographic angiography, followed by visceral angiography, was used to confirm the diagnosis of multisite visceral artery pseudoaneurysms, secondary to severe, necrotising pancreatitis. Pseudoaneurysms of the splenic, left colic and gastroduodenal arteries were sequentially, and successfully, radiologically embolised over a period of 9 days. Subsequent sequelae of radiological embolisation included a clinically insignificant splenic infarct, and a left colonic infarction associated with subsequent enterocutaneous fistula formation. The patient made a prolonged, but successful, recovery and was discharged from hospital after 260 days as an in-patient. This case illustrates the rare complication of three separate pseudoaneurysms, secondary to acute pancreatitis, successfully managed radiologically in the same patient. This case also highlights the necessity for multidisciplinary involvement in the management of pseudoaneurysms, an approach that is often most successfully achieved in a tertiary setting.
我们报告一例45岁男性病例，该患者在一次酗酒 binge 后因严重上腹部疼痛前往当地急诊部就诊，随后被诊断为急性胰腺炎。继而出现胰腺坏死并伴有多处积液，因此需要转至一家三级肝胆胰中心的重症监护病房（ITU）。最初，患者似乎在缓慢好转并被转至病房，尽管在ITU住院时间较长。然而，在随后的恢复过程中，他多次出现呕血和黑便，伴有血流动力学不稳定，需要再次入住ITU。通过计算机断层血管造影，随后进行内脏血管造影，以确诊继发于严重坏死性胰腺炎的多部位内脏动脉假性动脉瘤。在9天的时间里，依次对脾动脉、左结肠动脉和胃十二指肠动脉的假性动脉瘤进行了成功的放射栓塞治疗。放射栓塞的后续后遗症包括临床上无明显意义的脾梗死，以及与随后的肠皮肤瘘形成相关的左结肠梗死。患者经过漫长但成功的恢复过程，作为住院患者在260天后出院。该病例说明了急性胰腺炎继发的三个独立假性动脉瘤这种罕见并发症，在同一患者中通过放射治疗成功得到处理。该病例还强调了多学科参与假性动脉瘤管理的必要性，这种方法通常在三级医疗机构中最能成功实现。
