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内镜下消化道检查术后急性胰腺炎:病例报告及该罕见术后并发症的文献综述

Acute Pancreatitis after EGD: Case Presentation and Literature Review of this Rare Post-Procedure Complication.

作者信息

Gaddameedi Sai Rakshith, Rathod Malay, Ravilla Jayashree, Chinchwadkar Ojas, Vangala Anoohya, Terrany Ben, Du Doantrang

机构信息

Internal Medicine Department, Rutgers Health/Monmouth Medical Center, Long Branch, USA.

Rutgers Robert Wood Johnson Medical School, New Brunswick, USA.

出版信息

Eur J Case Rep Intern Med. 2024 Jul 1;11(8):004680. doi: 10.12890/2024_004680. eCollection 2024.

Abstract

BACKGROUND

Acute pancreatitis is a common cause of hospitalisation characterised by inflammation of the pancreas. While mechanical, toxic and iatrogenic factors typically cause it, post-oesophagogastroduodenoscopy (EGD) pancreatitis is extremely rare. This report examines a case of acute pancreatitis following EGD, aiming to highlight this rare but significant complication.

CASE DESCRIPTION

A 46-year-old woman with a history of breast cancer, anxiety, vitamin D deficiency and gastro-oesophageal reflux disease underwent an EGD, which revealed and led to the removal of duodenal polyps. Six hours post-procedure, she presented with severe abdominal pain radiating to her back, accompanied by nausea. Laboratory results indicated elevated lipase levels, and a computed tomography (CT) scan confirmed acute pancreatitis. The patient was managed with aggressive fluid resuscitation, bowel rest and pain management, leading to an improvement in her condition and subsequent discharge. We believe that the pancreatitis was likely caused by the use of cautery during the endoscopic mucosal resection of duodenal polyps.

CONCLUSION

This case underscores the need for clinicians to recognise acute pancreatitis as a potential complication of EGD, especially in the absence of other common risk factors.

LEARNING POINTS

Acute pancreatitis following oesophagogastroduodenoscopy (EGD) is an uncommon but significant complication.Possible mechanisms include mechanical trauma, gas insufflation or electrical injury during endoscopic mucosal resection.Clinicians should be aware of this potential complication, especially when no typical aetiological factors for pancreatitis are present.

摘要

背景

急性胰腺炎是住院治疗的常见病因,其特征为胰腺炎症。虽然机械性、毒性和医源性因素通常会引发该病,但食管胃十二指肠镜检查(EGD)后胰腺炎极为罕见。本报告探讨了1例EGD术后急性胰腺炎病例,旨在突出这一罕见但严重的并发症。

病例描述

一名46岁女性,有乳腺癌、焦虑症、维生素D缺乏症和胃食管反流病病史,接受了EGD检查,检查发现并切除了十二指肠息肉。术后6小时,她出现严重腹痛并放射至背部,伴有恶心。实验室检查结果显示脂肪酶水平升高,计算机断层扫描(CT)证实为急性胰腺炎。该患者接受了积极的液体复苏、肠道休息和疼痛管理,病情得到改善并随后出院。我们认为,胰腺炎可能是在十二指肠息肉内镜黏膜切除术中使用电灼术所致。

结论

该病例强调临床医生需要认识到急性胰腺炎是EGD的一种潜在并发症,尤其是在没有其他常见危险因素的情况下。

经验教训

食管胃十二指肠镜检查(EGD)后急性胰腺炎是一种罕见但严重的并发症。可能的机制包括机械性创伤、内镜黏膜切除术中的气体注入或电损伤。临床医生应意识到这一潜在并发症,尤其是在不存在胰腺炎典型病因的情况下。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/aea1/11313113/cce7527e9585/4680_Fig1.jpg

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