Hoshimoto Sojun, Aiura Koichi, Shito Masaya, Kakefuda Toshihiro, Sugiura Hitoshi
Department of Surgery, Kawasaki Municipal Hospital, Kawasaki, 210-0013, Kanagawa, Japan.
Department of Pathology, Kawasaki Municipal Hospital, Kawasaki, 210-0013, Kanagawa, Japan.
World J Surg Oncol. 2016 Feb 24;14(1):46. doi: 10.1186/s12957-016-0812-x.
Hematemesis is uncommon as an initial presenting symptom in pancreatic cancer. We present herein a case of a pseudoaneurysm that ruptured and fistulized into the stomach. The pseudoaneurysm was secondary to a pancreatic pseudocyst complicating obstructive pancreatitis due to pancreatic cancer. The patient was successfully treated using trans-arterial embolization followed by curative surgery.
A 61-year-old man presented to the emergency room with hematemesis. Laboratory examinations revealed a low level of hemoglobin (5.0 g/dl). The patient had presented to another hospital due to hematemesis 1 month before presenting to our hospital. A low-density mass in the pancreatic body with dilatation of the distal main pancreatic duct and a pseudocyst in the pancreatic tail had been observed by radiology at the previous hospital. Further investigation had been planned. Abdominal computed tomography on admission to our hospital demonstrated a pseudoaneurysm in close contact with the wall of the pseudocyst of the pancreatic tail, compressing the stomach. The pseudoaneurysm had not been detected by abdominal computed tomography at the previous hospital. Emergency selective angiography revealed that the pseudoaneurysm arose from the left gastroepiploic artery branching from the splenic artery. Trans-arterial embolization of the left gastroepiploic artery through the splenic artery was successfully performed. Elective distal pancreatectomy and splenectomy with regional lymph node dissection combined with partial resection of the stomach was performed 3 weeks after coil embolization. Pathological examination revealed a moderately differentiated tubular adenocarcinoma in the pancreatic body with regional lymph node metastasis and revealed the pseudoaneurysm rupturing into the pancreatic pseudocyst. The patient has experienced no tumor recurrence or metastasis during 1 year of follow-up.
Spontaneous rupture of a pseudoaneurysm is a rare and potentially lethal complication of a pancreatic pseudocyst. Most affected patients have a history of alcoholism and suffer from acute or chronic pancreatitis. To our knowledge, this is the first reported case of a hemorrhagic pancreatic pseudocyst complicating obstructive pancreatitis due to pancreatic cancer.
呕血作为胰腺癌的首发症状并不常见。我们在此报告一例假性动脉瘤破裂并形成胃瘘的病例。该假性动脉瘤继发于胰腺癌合并梗阻性胰腺炎所致的胰腺假性囊肿。患者经动脉栓塞治疗后成功接受了根治性手术。
一名61岁男性因呕血就诊于急诊室。实验室检查显示血红蛋白水平较低（5.0 g/dl）。该患者在来我院就诊前1个月因呕血曾就诊于另一家医院。前一家医院的放射检查发现胰体部有一个低密度肿块，主胰管远端扩张，胰尾部有一个假性囊肿。原计划进一步检查。我院入院时的腹部计算机断层扫描显示，胰尾部假性囊肿壁附近有一个假性动脉瘤，压迫胃。前一家医院的腹部计算机断层扫描未检测到该假性动脉瘤。急诊选择性血管造影显示，假性动脉瘤起源于脾动脉分支的胃网膜左动脉。通过脾动脉成功地对胃网膜左动脉进行了经动脉栓塞。在弹簧圈栓塞3周后，择期行远端胰腺切除术、脾切除术及区域淋巴结清扫术，并联合部分胃切除术。病理检查显示胰体部为中分化管状腺癌，有区域淋巴结转移，假性动脉瘤破裂进入胰腺假性囊肿。患者在1年的随访中未出现肿瘤复发或转移。
假性动脉瘤自发破裂是胰腺假性囊肿罕见且可能致命的并发症。大多数受影响的患者有酗酒史，患有急性或慢性胰腺炎。据我们所知，这是首例因胰腺癌合并梗阻性胰腺炎导致出血性胰腺假性囊肿的报道病例。
