Department of Internal Medicine, Diakonie-Krankenhaus Wehrda, Marburg, Germany.
Am J Med Sci. 2013 Aug;346(2):160-1. doi: 10.1097/MAJ.0b013e3182805779.
Pleural effusions and ascites are not uncommon in acute pancreatitis; however, pericardial effusions complicated by cardiac tamponade are extremely rare and definite treatment has yet to be established. This case report illustrates the findings in a 57-year-old patient, who was diagnosed of an acute alcoholic pancreatitis. The clinical course was complicated by recurrent episodes of acute pancreatitis, and eventually, the patient developed acute circulatory failure that was caused by cardiac tamponade. The patient was successfully treated by an emergency pericardiocentesis; however, although the patient was treated with intrapericardial triamcinolone and octreotide, pericardial effusion reoccurred. Eventually, a pancreaticopericardial fistula was diagnosed by endoscopic retrograde cholangiopancreaticography, and after successful stent placement in a disrupted pancreatic duct, the clinical recovery was uneventful. To the best of the authors' knowledge, this is the first case of a successful endoscopic treatment of a pancreaticopericardial fistula complicated by cardiac tamponade in a patient with acute pancreatitis.
胸腔积液和腹水在急性胰腺炎中并不少见；然而，心包积液并发心脏压塞则极为罕见，且确切的治疗方法尚未确定。本病例报告介绍了一位 57 岁患者的发现情况，该患者被诊断为急性酒精性胰腺炎。临床病程复杂，反复发作急性胰腺炎，最终患者发生急性循环衰竭，由心脏压塞引起。患者通过紧急心包穿刺术成功治疗；然而，尽管患者接受了心包内曲安奈德和奥曲肽治疗，但心包积液再次出现。最终，通过内镜逆行胰胆管造影诊断为胰心瘘，在破坏的胰管成功放置支架后，临床恢复顺利。据作者所知，这是首例成功内镜治疗急性胰腺炎并发心脏压塞的胰心瘘病例。
