Matsubara Kazuyoshi, Matsukura Mitsuru, Takayama Toshio, Hoshina Katsuyuki, Kanemoto Hideyuki
Division of Vascular Surgery, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Department of Gastroenterological Surgery, Shizuoka General Hospital, Shizuoka, Japan.
EJVES Vasc Forum. 2022 Apr 14;55:56-58. doi: 10.1016/j.ejvsvf.2022.04.001. eCollection 2022.
Two cases of haemosuccus pancreaticus (HP), a rare cause of gastrointestinal bleeding caused by splenic artery aneurysm derived from isolated spontaneous coeliac artery dissection (ISCAD), are reported.
The first case was a 62-year-old man with a history of hypertension who presented with abdominal pain and melaena. Laboratory tests indicated slight anaemia and a high serum amylase level. Computed tomography (CT) showed coeliac artery dissection and a splenic aneurysm. Endoscopic retrograde cholangiopancreatography suggested a communication between the main pancreatic duct and the aneurysm. A laparoscopic distal pancreatectomy was performed. The second case was a 49-year-old man who had been followed up with coeliac artery dissection and a splenic aneurysm, and developed abdominal pain, haematemesis, and melaena. CT did not show degeneration of the coeliac and splenic lesions, and multiple endoscopies failed to detect the source of bleeding. However, the patient was clinically diagnosed with HP and had a successful transcatheter arterial embolisation. There was no recurrence in either case.
HP should be considered in cases with adjacent splenic aneurysms, especially under fragile arterial conditions such as ISCAD.
报告两例血腹性胰腺炎（HP），这是一种由孤立性自发性腹腔动脉夹层（ISCAD）导致的脾动脉瘤引起的罕见胃肠道出血病因。
第一例为一名62岁男性，有高血压病史，出现腹痛和黑便。实验室检查显示轻度贫血和血清淀粉酶水平升高。计算机断层扫描（CT）显示腹腔动脉夹层和脾动脉瘤。内镜逆行胰胆管造影提示主胰管与动脉瘤之间存在交通。实施了腹腔镜远端胰腺切除术。第二例为一名49岁男性，此前因腹腔动脉夹层和脾动脉瘤接受随访，出现腹痛、呕血和黑便。CT未显示腹腔和脾脏病变的恶化，多次内镜检查未能发现出血源。然而，该患者临床诊断为HP，并成功进行了经导管动脉栓塞术。两例均无复发。
对于伴有相邻脾动脉瘤的病例，尤其是在如ISCAD等动脉条件脆弱的情况下，应考虑血腹性胰腺炎。
