Cahow C E, Gusberg R J, Gottlieb L J
Am J Surg. 1983 Apr;145(4):534-41. doi: 10.1016/0002-9610(83)90054-5.
Gastrointestinal hemorrhage secondary to hemosuccus pancreaticus is a rare condition that poses a significant diagnostic and therapeutic challenge. It is reported to occur most commonly in the setting of acute or chronic pancreatitis with rupture of pseudoaneurysms of the spleen or hepatic artery into the pancreatic duct. In this report three such cases have been reported. Abdominal ultrasound and CT scanning can noninvasively define pancreatic pseudocysts with a high degree of accuracy. Real-time ultrasonography may document a pulsatile pseudoaneurysm. Radionuclide arterial scanning, by demonstrating pooling of blood in the area of a pseudocyst, can point to the source of bleeding in patients with pancreatitis and gastrointestinal hemorrhage. Selective celiac angiography, however, is the only diagnostic test that can definitively outline a pseudoaneurysm and demonstrate its rupture into a pseudocyst or into the pancreatic duct. Pancreatic resection including excision of the pseudoaneurysm and pseudocyst (when present) is the treatment of choice. In cases where resection is not possible, ligation of the artery proximal and distal to the pseudoaneurysm and drainage of the pseudocyst into the gastrointestinal tract is an acceptable alternative procedure. Although intraarterial catheter embolization of the bleeding vessel can be a lifesaving procedure in these very sick patients, subsequent resection of the lesion is warranted as the definitive treatment.
胰源性腹水继发胃肠道出血是一种罕见的病症，对诊断和治疗构成重大挑战。据报道，它最常发生于急性或慢性胰腺炎的情况下，脾或肝动脉假性动脉瘤破裂进入胰管。本报告报道了3例此类病例。腹部超声和CT扫描能够以高度准确性无创地确定胰腺假性囊肿。实时超声检查可能会记录到搏动性假性动脉瘤。放射性核素动脉扫描通过显示假性囊肿区域的血液积聚，可指出胰腺炎合并胃肠道出血患者的出血来源。然而，选择性腹腔动脉造影是唯一能够明确勾勒假性动脉瘤并显示其破裂进入假性囊肿或胰管的诊断性检查。包括切除假性动脉瘤和假性囊肿（如有）在内的胰腺切除术是首选治疗方法。在无法进行切除的情况下，结扎假性动脉瘤近端和远端的动脉，并将假性囊肿引流至胃肠道是一种可接受的替代手术。尽管对这些病情严重的患者进行出血血管的动脉内导管栓塞术可能是一种挽救生命的手术，但后续切除病变作为确定性治疗是必要的。
