Scalera Irene, Kumar Senthil, Bramhall Simon
Department of Hepato-biliary-pancreatic Surgery and Liver Transplantation, University Hospital Birmingham NHS Trust. Birmingham, UK.
JOP. 2012 Nov 10;13(6):690-2. doi: 10.6092/1590-8577/1039.
Focal post-traumatic acute pancreatitis causing combined duodenal and biliary obstruction is extremely rare.
A 16-year-old boy presented with acute upper abdominal pain which was clinically and biochemically consistent with mild acute pancreatitis. There was no etiological factor identified initially, although a history of blunt abdominal trauma was later discovered. He soon developed features of gastric outlet obstruction and obstructive jaundice over 48 hours. A CT scan showed a retroduodenal mass causing compression of both the duodenum and bile duct. At exploration, this was found to be a walled off hematoma. There was evidence of focal pancreatitis in the head of pancreas. Evacuation of the hematoma cured the gastric outlet and biliary obstruction.
The triad of pancreatitis, gastric outlet and biliary obstruction along with a mass lesion on cross sectional imaging in young adults should raise the suspicion of a hematoma as a probable cause.
创伤后局灶性急性胰腺炎导致十二指肠和胆管联合梗阻极为罕见。
一名16岁男孩出现急性上腹痛，临床和生化检查结果与轻度急性胰腺炎相符。最初未发现病因，尽管后来发现有腹部钝性外伤史。48小时内，他很快出现胃出口梗阻和梗阻性黄疸的症状。CT扫描显示十二指肠后有一肿块，压迫十二指肠和胆管。手术探查发现这是一个包裹性血肿。有证据表明胰腺头部存在局灶性胰腺炎。血肿清除后治愈了胃出口和胆管梗阻。
在年轻人中，胰腺炎、胃出口和胆管梗阻三联征以及横断面成像上的肿块病变应引起怀疑，血肿可能是病因。
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