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全麻下丙泊酚非腹部手术后即刻发生重症坏死性胰腺炎。

Severe necrotizing pancreatitis immediately after non-abdominal surgery under general anesthesia with propofol.

机构信息

Faculty of Medical Sciences, Second Department of Internal Medicine, University of Fukui, 23-3 Matsuoka Shimoaizuki, Eiheiji-cho, Fukui, Yoshida-gun, 910-1193, Japan.

出版信息

Clin J Gastroenterol. 2021 Dec;14(6):1798-1803. doi: 10.1007/s12328-021-01504-5. Epub 2021 Aug 26.

Abstract

Postoperative pancreatitis is a relatively rare disease and is poorly recognized. Herein, we present a case of necrotizing pancreatitis that developed immediately after non-abdominal surgery under general anesthesia. In this report, 4 h after thyroidectomy under general anesthesia using propofol, the patient developed upper abdominal pain and was diagnosed with severe acute pancreatitis with extensive pancreatic necrosis. Immediately after the diagnosis, the patient received appropriate treatment, and acute pancreatitis was improved. Subsequently, the patient has the formation of non-infectious giant walled-off necrosis and remained in good condition without additional treatment for 1.5 years after pancreatitis onset. In this case report, our detailed causative search suggested that propofol administration could be the cause of this pancreatitis. Propofol-induced pancreatitis is extremely rare but develops often severely, resulting in fatality. In this case, the patient developed severe acute pancreatitis within a very short time after surgery but was able to survive by immediate intervention of treatment. We suggest that clinicians should consider acute pancreatitis as a life-threatening adverse event under general anesthesia with propofol and perform thorough postoperative management.

摘要

术后胰腺炎是一种相对罕见的疾病,认识不足。在此,我们报告了一例在全身麻醉下进行非腹部手术后立即发生坏死性胰腺炎的病例。在本报告中,患者在全身麻醉下使用丙泊酚行甲状腺切除术后 4 小时出现上腹痛,诊断为广泛胰腺坏死的重症急性胰腺炎。在诊断后,患者立即接受了适当的治疗,急性胰腺炎得到了改善。随后,患者形成了非感染性巨大分隔坏死,并在胰腺炎发病后 1.5 年保持良好状态,无需进一步治疗。在本病例报告中,我们详细的病因搜索提示丙泊酚给药可能是导致胰腺炎的原因。丙泊酚诱导的胰腺炎极为罕见,但发病往往很严重,导致死亡。在这种情况下,患者在手术后很短的时间内就发生了重症急性胰腺炎,但通过立即治疗干预得以存活。我们建议临床医生应考虑在使用丙泊酚全身麻醉下发生的危及生命的急性胰腺炎,并进行彻底的术后管理。

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