Reddymasu Savio, Oropeza-Vail Melissa M, Williamson Stephen, Jafri Faisal, Olyaee Mojtaba
Division of Gastroenterology, Department of Medicine, Creighton University Medical Center, Omaha, NE, USA.
JOP. 2011 Sep 9;12(5):489-90.
Endoscopic ultrasonography guided fine needle aspiration (EUS-FNA) is a front line test used for the diagnosis of solid as well as cystic lesions of the pancreas. This procedure is fairly well tolerated and associated with minimal complications. Local complications such as perforation and pancreatitis have been reported with EUS-FNA, albeit rarely. Although pancreatic duct injury can occur during EUS-FNA, symptomatic pancreatic duct leak as a complication of this procedure has never been reported.
We present a 67-year-old patient who developed symptomatic ascites after EUS-FNA of a pancreatic neck lesion that required several paracenteses. Analysis of the ascitic fluid revealed that the fluid amylase and lipase levels were very high consistent with pancreatic ascites. An endoscopic retrograde pancreatography was subsequently performed that documented the presence of a pancreatic duct leak in the neck. The pancreatic duct leak and the ascites resolved after placing a pancreatic duct stent.
A clinically significant pancreatic leak can occur as a rare complication of EUS-FNA that can be effectively managed by endoscopic retrograde pancreatography and placement of a transpapillary pancreatic duct stent.
超声内镜引导下细针穿刺抽吸术（EUS-FNA）是用于诊断胰腺实性及囊性病变的一线检查方法。该操作耐受性良好，并发症极少。虽然有报道称EUS-FNA会出现诸如穿孔和胰腺炎等局部并发症，但极为罕见。尽管在EUS-FNA过程中可能发生胰管损伤，但作为该操作并发症的有症状胰管漏从未被报道过。
我们报告一例67岁患者，其在对胰腺颈部病变进行EUS-FNA后出现有症状的腹水，需要多次腹腔穿刺引流。腹水分析显示，腹水淀粉酶和脂肪酶水平非常高，符合胰源性腹水。随后进行了内镜逆行胰胆管造影，证实颈部存在胰管漏。放置胰管支架后，胰管漏和腹水均得到缓解。
作为EUS-FNA的一种罕见并发症，可能会出现具有临床意义的胰漏，可通过内镜逆行胰胆管造影和经乳头放置胰管支架有效处理。
