Rapetti Rachele, Scaglia Elena, Fangazio Stefano, Burlone Michela Emma, Leutner Monica, Pirisi Mario
Department of Clinical and Experimental Medicine, University of Eastern Piedmont 'A. Avogadro', Novara, Italy.
Case Rep Gastroenterol. 2008 Sep;2(3):433-8. doi: 10.1159/000161567. Epub 2008 Nov 14.
A 65-year-old man with chronic hepatitis C and no history of alcohol abuse was admitted to our liver unit for the recent development of massive ascites and presumed hepatorenal syndrome. In the preceding two weeks, he had received medical treatment for acute pancreatitis and cholecystitis. Abdominal paracentesis demonstrated a cloudy, orange peritoneal fluid, with total protein concentration 3.6 g/dl, serum-ascites albumin gradient 1.0 g/dl, and ratios of ascites-serum bilirubin and amylase approximately 8:1. Diagnostic imaging demonstrated no pancreatic pseudocysts. Ten days later, at laparotomy, acalculous perforation of the gallbladder was identified. After cholecystectomy, amylase concentration in the ascitic fluid dropped within a few days to 40% of serum values; ascites disappeared within a few weeks. We conclude that in the presence of a perforated gallbladder, pancreatobiliary reflux was responsible for this unusual combination of choleperitoneum and pancreatic ascites, which we propose to call pancreatobiliary ascites.
一名65岁男性，患有慢性丙型肝炎，无酗酒史，因近期出现大量腹水及疑似肝肾综合征入住我院肝病科。在之前的两周里，他因急性胰腺炎和胆囊炎接受了治疗。腹腔穿刺抽出浑浊的橙色腹水，总蛋白浓度为3.6 g/dl，血清-腹水白蛋白梯度为1.0 g/dl，腹水-血清胆红素和淀粉酶比值约为8:1。诊断性影像学检查未发现胰腺假性囊肿。十天后，剖腹手术时发现胆囊无结石穿孔。胆囊切除术后，腹水淀粉酶浓度在数天内降至血清值的40%；腹水在数周内消失。我们得出结论，在存在胆囊穿孔的情况下，胰胆反流是导致这种胆汁性腹膜炎和胰性腹水异常组合的原因，我们建议将其称为胰胆性腹水。
