Yasuda Takeo, Kamei Keiko, Araki Mariko, Nakata Yasuyuki, Ishikawa Hajime, Yamazaki Mitsuo, Sakamoto Hiroki, Kitano Masayuki, Nakai Takuya, Takeyama Yoshifumi
Department of Surgery, Department of Internal Medicine, Kinki University Faculty of Medicine, Osakasayama, Japan.
Case Rep Gastroenterol. 2013 Aug 9;7(2):322-6. doi: 10.1159/000354723. eCollection 2013.
A 39-year-old man was referred to our hospital for the investigation of abdominal fluid collection. He was pointed out to have alcoholic chronic pancreatitis. Laboratory data showed inflammation and slightly elevated serum direct bilirubin and amylase. An abdominal computed tomography demonstrated huge fluid collection, multiple pancreatic pseudocysts and pancreatic calcification. The fluid showed a high level of amylase at 4,490 IU/l. Under the diagnosis of pancreatic ascites, endoscopic pancreatic stent insertion was attempted but was unsuccessful, so surgical treatment (Frey procedure and cystojejunostomy) was performed. During the operation, a huge amount of fluid containing bile acid (amylase at 1,474 IU/l and bilirubin at 13.5 mg/dl) was found to exist in the extraperitoneal space (over the peritoneum), but no ascites was found. His postoperative course was uneventful and he shows no recurrence of the fluid. Pancreatic ascites is thought to result from the disruption of the main pancreatic duct, the rupture of a pancreatic pseudocyst, or possibly leakage from an unknown site. In our extremely rare case, the pancreatic pseudocyst penetrated into the hepatoduodenal ligament with communication to the common bile duct, and the fluid flowed into the round ligament of the liver and next into the extraperitoneal space.
一名39岁男性因腹腔积液检查被转诊至我院。他被诊断为酒精性慢性胰腺炎。实验室检查显示有炎症，血清直接胆红素和淀粉酶略有升高。腹部计算机断层扫描显示有大量积液、多个胰腺假性囊肿和胰腺钙化。积液淀粉酶水平高达4490 IU/l。在诊断为胰源性腹水后，尝试进行内镜下胰腺支架置入但未成功，因此进行了手术治疗（Frey手术和囊肿空肠吻合术）。手术过程中，发现腹膜外间隙（腹膜上方）存在大量含有胆汁酸的液体（淀粉酶1474 IU/l，胆红素13.5 mg/dl），但未发现腹水。他术后恢复顺利，未出现液体复发。胰源性腹水被认为是由于主胰管破裂、胰腺假性囊肿破裂或可能来自未知部位的渗漏所致。在我们这例极为罕见的病例中，胰腺假性囊肿穿透至肝十二指肠韧带并与胆总管相通，液体流入肝圆韧带，进而进入腹膜外间隙。
