Fujinaga Kazuhisa, Nakahashi Hiroki, Shomi Yuta, Haruki Yuji, Kato Kenji
Dept. of Surgery, Matsusaka Municipal Hospital.
Gan To Kagaku Ryoho. 2020 Dec;47(13):2159-2161.
The patient was a 76-year-old woman who was referred to our department for jaundice. From further evaluation, resectable cancer of the pancreas head was diagnosed. The patient did not want to undergo surgery, although it had been planned. Thus, we performed biliary stenting and subsequently applied chemoradiotherapy. Then, the patient underwent the best supportive care(BSC). Eleven months after the diagnosis of the pancreatic cancer, she presented with hematemesis while in the hospital for a lumbar compression fracture, and her vital signs showed that she was in shock. Emergency endoscopic examination of the upper gastrointestinal tract revealed bleeding from the duodenal bulb. Endoscopic hemostasis was difficult; therefore, emergency interventional radiology(IVR)was conducted. Owing to the ruptured gastrointestinal pseudoaneurysm in the duodenum, embolization was performed. The 2nd-look endoscopic examination of the upper gastrointestinal tract showed that the biliary stent was exposed to the duodenal bulb, which led to the formation of a choledochoduodenal fistula. As the subsequent course, the patient received conservative treatment and had no onset of retrograde choledochitis; however, the patient died due to the original cancer 15 months after the diagnosis and 4 months after the bleeding.
该患者为一名76岁女性，因黄疸转诊至我科。经进一步评估，诊断为可切除的胰头癌。尽管已计划进行手术，但患者不想接受手术。因此，我们进行了胆道支架置入术，随后进行了放化疗。然后，患者接受了最佳支持治疗（BSC）。胰腺癌诊断11个月后，她因腰椎压缩性骨折住院期间出现呕血，生命体征显示她处于休克状态。对上消化道进行紧急内镜检查发现十二指肠球部出血。内镜止血困难；因此，进行了紧急介入放射学（IVR）治疗。由于十二指肠胃肠道假性动脉瘤破裂，进行了栓塞治疗。对上消化道进行的二次内镜检查显示，胆道支架暴露于十二指肠球部，导致胆总管十二指肠瘘形成。在随后的病程中，患者接受了保守治疗，未发生逆行性胆管炎；然而，患者在诊断后15个月和出血后4个月因原发癌症死亡。
