胰腺炎继发壁内十二指肠血肿：病例报告及文献复习
Intramural duodenal hematoma secondary to pancreatitis: case report and review of the literature.
作者信息
Oliveira João Henrique Botto de, Esper Raiza Samenica, Ocariz Rodrigo Campos, Sartori Flora Specian, Freire Lucas Marcelo Dias, Chaim Elinton Adami, Callejas-Neto Francisco, Cazzo Everton
机构信息
MD. Resident Physician, Department of Surgery, Centro Médico de Campinas (CMC), Campinas (SP), Brazil.
MD. Attending Physician, Endovascular Surgery Unit, Centro Médico de Campinas (CMC), Campinas (SP), Brazil.
出版信息
Sao Paulo Med J. 2018;136(6):597-601. doi: 10.1590/1516-3180.2017.0134290517. Epub 2017 Dec 7.
CONTEXT
Spontaneous intramural duodenal hematoma is uncommon and is usually associated with coagulopathy, anticoagulant therapy and endoscopic procedures. The aim here was to describe a case of intramural duodenal hematoma caused by chronic exacerbation of pancreatitis.
CASE REPORT
A 46-year-old male with chronic alcoholic pancreatitis was admitted to hospital due to abdominal pain, melena and low hemoglobin. An intramural duodenal hematoma with active bleeding was detected and selective angioembolization was warranted. The patient evolved with a perforated duodenum and underwent laparotomy with exclusion of the pylorus and Roux-en-Y gastrojejunostomy. He was discharged nine days later.
CONCLUSION
Intramural duodenal hematoma is a rare complication of pancreatitis. Selective embolization is the preferred treatment for hemorrhagic complications of pancreatitis. However, the risk of visceral ischemia and perforation should be considered.
背景
自发性十二指肠壁内血肿并不常见，通常与凝血病、抗凝治疗及内镜操作有关。本文旨在描述一例由胰腺炎慢性加重引起的十二指肠壁内血肿病例。
病例报告
一名46岁慢性酒精性胰腺炎男性因腹痛、黑便及血红蛋白降低入院。检查发现十二指肠壁内血肿并伴有活动性出血，遂行选择性血管栓塞术。患者病情进展为十二指肠穿孔，接受了幽门旷置术及Roux-en-Y胃空肠吻合术。九天后出院。
结论
十二指肠壁内血肿是胰腺炎的一种罕见并发症。选择性栓塞术是胰腺炎出血并发症的首选治疗方法。然而，应考虑内脏缺血和穿孔的风险。
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