Lee Sun Hwa, Yun Seong Jong, Ryu Seokyong, Choi Seung Woon, Kim Hye Jin, Kang Tae Kyung, Oh Sung Chan, Cho Suk Jin
Department of Emergency Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea.
Department of Radiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Republic of Korea.
J Emerg Med. 2018 Jul;55(1):e5-e8. doi: 10.1016/j.jemermed.2018.04.012. Epub 2018 May 7.
Acute pancreatitis may cause massive intra-abdominal bleeding as vascular complications caused by the erosion of a major pancreatic or peripancreatic vessel. In terms of treatment, the differentiation between arterial bleeding and venous bleeding using abdominal computed tomography (CT) angiography is important. In addition, hypovolemic shock caused by bleeding from the inferior mesenteric vein (IMV) in acute pancreatitis has not been reported.
A 58-year-old man presented to our emergency department with complaints of abdominal pain of 10 hours' duration. The pain had an abrupt onset and started with alcohol consumption. After performing initial laboratory tests and an abdominal CT scan, he was diagnosed with acute pancreatitis. However, he complained of severe abdominal pain and was drowsy 2 h later. Follow-up CT angiography revealed acute necrotizing pancreatitis with massive hemoperitoneum and hypovolemic shock. We also found active bleeding from the IMV. We did not consider emergency catheter angiography with embolization; instead, exploratory laparotomy and hematoma evacuation with IMV ligation was performed. He was discharged without complications 14 days later. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Massive bleeding from the IMV accompanied by shock bowel syndrome is a rare complication of acute pancreatitis that can be confused with arterial bleeding. Emergency physicians should consider this diagnosis in acute pancreatitis as a possible cause of hypovolemic shock and anatomic course of the IMV and prevent fulminant shock by administering appropriate treatment.
急性胰腺炎可能会导致大量腹腔内出血，这是由主要胰腺或胰腺周围血管受侵蚀引起的血管并发症。在治疗方面，利用腹部计算机断层扫描（CT）血管造影区分动脉出血和静脉出血很重要。此外，急性胰腺炎时肠系膜下静脉（IMV）出血导致的低血容量性休克尚未见报道。
一名58岁男性因持续10小时的腹痛主诉就诊于我院急诊科。疼痛突发，起于饮酒后。在进行初步实验室检查和腹部CT扫描后，他被诊断为急性胰腺炎。然而，2小时后他主诉腹痛剧烈且嗜睡。后续CT血管造影显示急性坏死性胰腺炎伴大量腹腔积血和低血容量性休克。我们还发现IMV有活动性出血。我们未考虑行急诊导管血管造影栓塞术；而是进行了剖腹探查和IMV结扎血肿清除术。14天后他无并发症出院。急诊医生为何应知晓此事？：IMV大量出血伴休克肠综合征是急性胰腺炎的一种罕见并发症，可能与动脉出血混淆。急诊医生在急性胰腺炎患者中应考虑此诊断，将其作为低血容量性休克的可能原因及IMV的解剖走行，并通过给予适当治疗预防暴发性休克。
