Zaborowski Alexandra, Walsh Siun M, Ravi Narayanasamy, Reynolds John V
Department of Surgery, Trinity Centre, St. James's Hospital, James's Street, Dublin 8, Ireland.
Case Rep Surg. 2016;2016:5491851. doi: 10.1155/2016/5491851. Epub 2016 Feb 29.
We present herein what we believe is the first reported case of massive upper gastrointestinal bleeding in pregnancy due to a pancreatic neuroendocrine tumour causing left sided portal hypertension. A 37-year-old 27-week pregnant female presented with massive haematemesis and melaena requiring transfusion of 10 units of red cell concentrate. Gastric varices were evident at endoscopy. An MRI revealed a large mass infiltrating the pancreatic tail and spleen with massive upper abdominal varix formation secondary to splenic vein invasion. A caesarean section was performed, followed by a radical en bloc partial pancreatectomy and splenectomy with resection of the fundus of the stomach and ligation of gastric and splenic varices. Her postoperative course was uncomplicated. Histology revealed a well differentiated grade 2 neuroendocrine tumour with final staging of T4N0. This case highlights an infrequently encountered cause of massive gastrointestinal bleeding. Diagnosis and management of pancreatic neuroendocrine tumours, due to their rarity and variable clinical presentation, can be challenging particularly in the setting of pregnancy where the wellbeing of a second patient must also be considered. A multidisciplinary approach with input from obstetricians and general surgeons is required when deciding optimum management, while also taking into account the patient's preferences.
我们在此报告我们认为是首例因胰腺神经内分泌肿瘤导致左侧门静脉高压而引起妊娠期大量上消化道出血的病例。一名37岁、孕27周的女性出现大量呕血和黑便，需要输注10单位红细胞浓缩液。内镜检查可见胃静脉曲张。磁共振成像（MRI）显示一个大肿块浸润胰尾和脾脏，继发脾静脉受侵后形成大量上腹部静脉曲张。行剖宫产术，随后行根治性整块部分胰腺切除术和脾切除术，并切除胃底，结扎胃和脾静脉曲张。她的术后过程顺利。组织学检查显示为高分化2级神经内分泌肿瘤，最终分期为T4N0。该病例突出了一种罕见的大量胃肠道出血原因。胰腺神经内分泌肿瘤因其罕见性和临床表现多样，其诊断和管理具有挑战性，尤其是在妊娠期，此时还必须考虑另一名患者（胎儿）的健康状况。在决定最佳治疗方案时，需要产科医生和普通外科医生多学科参与，同时也要考虑患者的偏好。
