Wang Jeremy, Thaker Adarsh M, Noor El-Nachef Wael, Watson Rabindra R
Department of Medicine, UCLA Medical Center, Los Angeles, CA.
Division of Digestive Diseases, UCLA Medical Center, Los Angeles, CA.
ACG Case Rep J. 2017 May 10;4:e66. doi: 10.14309/crj.2017.66. eCollection 2017.
Transhiatal herniation of the pancreas is rare. Acute pancreatitis secondary to this phenomenon is particularly unusual. A 102-year-old woman presented with 1 day of severe chest pain, vomiting, dyspnea, and diaphoresis. Serum lipase was elevated, and computed tomography angiogram of the chest and magnetic resonance cholangiopancreatography revealed a hiatal hernia containing the pancreas, with associated findings of pancreatitis. Pancreatitis in this setting may be due to repetitive trauma or ischemia from sliding, intermittent folding of the pancreatic duct, or pancreatic incarceration. Mild cases can be managed supportively, with surgery being reserved for severe cases or for younger patients with low surgical risk.
胰腺经膈裂孔疝极为罕见。继发于此现象的急性胰腺炎尤其少见。一名102岁女性因1天来的严重胸痛、呕吐、呼吸困难和多汗前来就诊。血清脂肪酶升高，胸部计算机断层血管造影和磁共振胰胆管造影显示有一个包含胰腺的食管裂孔疝，并伴有胰腺炎相关表现。这种情况下的胰腺炎可能是由于反复创伤或胰腺导管滑动、间歇性折叠或胰腺嵌顿导致的缺血。轻症病例可给予支持治疗，手术仅适用于重症病例或手术风险低的年轻患者。
