López de la Cruz Julia, Aso Gonzalvo María Concepción, Martínez Samuel Jesús, Borao Laguna Cristina, Millastre Bocos Judith
Hospital Clínico Lozano Blesa. Zaragoza.
Rev Gastroenterol Peru. 2022 Oct-Dec;42(4):261-263.
We present the case of a 64-year-old man who, after a first episode of acute pancreatitis, was readmitted 20 days later due to severe epigastric pain and later an episode of upper gastrointestinal bleeding in the form of hematemesis and melena with hemodynamic instability. An urgent gastroscopy was performed at that time, revealing a probable gastrointestinal fistula in the duodenal bulb with an adherent clot without active bleeding at that time, so an urgent CT angiography was performed that revealed a necrotic peripancreatic collection with the presence of active bleeding inside from the pancreatoduodenal artery. Urgent arteriography identified an image compatible with arterial pseudoaneurysm dependent on the pancreaticoduodenal artery branch, which was successfully embolized. Unfortunately, the patient died a few hours later as a result of septic shock secondary to an infected pancreatic collection.
我们报告一例64岁男性患者，其在首次发生急性胰腺炎后20天因严重上腹部疼痛再次入院，随后出现上消化道出血，表现为呕血和黑便，并伴有血流动力学不稳定。当时进行了紧急胃镜检查，发现十二指肠球部可能存在胃肠道瘘，伴有附着的血凝块，当时无活动性出血，因此进行了紧急CT血管造影，显示胰周有坏死性积液，胰十二指肠动脉内部存在活动性出血。紧急动脉造影发现与胰十二指肠动脉分支相关的动脉假性动脉瘤影像，该假性动脉瘤成功栓塞。不幸的是，患者数小时后因感染性胰周积液继发感染性休克死亡。
