保留幽门的胰头切除术后空结肠瘘：慢性腹泻的罕见原因
[Jejunocolic fistulae after pylorus-preserving pancreatic head resection: an uncommon cause of chronic diarrhea].
作者信息
Karlas Thomas, Markuske Matthias, Schierle Katrin, Mössner Joachim, Bartels Michael, Bödeker Hans
机构信息
Department für Innere Medizin, Neurologie und Dermatologie, Medizinische Klinik und Poliklinik für Gastroenterologie und Rheumatologie, Universitätsklinikum Leipzig AöR, Leipzig, Germany.
出版信息
Med Klin (Munich). 2010 Apr;105(4):253-7. doi: 10.1007/s00063-010-1033-7.
BACKGROUND
In patients with a history of pancreatic surgery, chronic diarrhea is mainly caused by exocrine pancreatic insufficiency. The authors report, for the first time, a case of jejunocolic fistulae as a cause of diarrhea and weight loss after pancreatic head resection.
CASE REPORT
A 55-year-old patient presented with chronic diarrhea and cachexia. He had undergone pylorus-preserving pancreatic head resection for chronic pancreatitis 8 years earlier. A recent colonoscopy showed an uncommon anatomy of the colon. Gastroscopy and computed tomography revealed several jejunocolic fistulae as the cause of chronic diarrhea. The patient underwent surgery and the fistula-carrying parts of jejunum and colon were resected. After surgery, his clinical status improved and he gained weight.
CONCLUSION
Interenteric fistulae after pylorus-preserving pancreatic head resection have not been reported so far. Impaired synchronization of gastric emptying and bile secretion could be a possible cause of autodigestion in the anastomosis region.
背景
有胰腺手术史的患者，慢性腹泻主要由胰腺外分泌功能不全引起。作者首次报告了一例空结肠瘘作为胰头切除术后腹泻和体重减轻原因的病例。
病例报告
一名55岁患者出现慢性腹泻和恶病质。他8年前因慢性胰腺炎接受了保留幽门的胰头切除术。近期结肠镜检查显示结肠解剖结构异常。胃镜和计算机断层扫描显示多个空结肠瘘是慢性腹泻的病因。患者接受了手术，切除了携带瘘管的空肠和结肠部分。术后，他的临床状况改善且体重增加。
结论
迄今为止，尚未报道保留幽门的胰头切除术后肠间瘘。胃排空与胆汁分泌同步受损可能是吻合口区域自身消化的一个可能原因。
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