Bradley E L, Clements J L
Ann Surg. 1981 May;193(5):638-48. doi: 10.1097/00000658-198105000-00015.
Intestinal obstruction as a complication of pancreatitis is infrequently recognized. Only four cases of idiopathic duodenal obstruction associated with pancreatitis have been previously reported. In a three-year study of 878 patients with pancreatitis, nine cases of idiopathic duodenal obstruction associated with pancreatitis have been found. Each of the nine cases was characterized by frank obstruction in the second or third portions of the duodenum and an intact mucosa in the area of stricture. Four patients gave an abrupt history of moderately severe pancreatitis. Resolution of the duodenal obstruction occurred by three weeks in each of these four cases. Surgical exploration in one of these patients revealed marked duodenal edema with intramural hematoma. The remaining five patients reported a chronic history of obstruction. Inadequate resolution of the obstruction after four weeks of hyperalimentation led to surgical bypass. Duodenal biopsy specimens revealed inflammation, muscle destruction, and extensive fibrosis. Duodenal involvement in the inflammatory process of moderately severe pancreatitis was discovered in 25% of the upper gastrointestinal studies, but was usually self-limiting and of a mild degree. Since contiguous duodenal edema is common and fibrosing pancreatoduodenitis only occurs in an occasional patient, surgical intervention for duodenal obstruction associated with pancreatitis should only be considered after demonstrated failure of conservative management.
肠梗阻作为胰腺炎的一种并发症很少被认识到。此前仅报道过4例与胰腺炎相关的特发性十二指肠梗阻病例。在一项对878例胰腺炎患者进行的为期三年的研究中，发现了9例与胰腺炎相关的特发性十二指肠梗阻病例。这9例病例均表现为十二指肠第二或第三部分的明显梗阻，狭窄区域黏膜完整。4例患者有中度重症胰腺炎的突发病史。这4例患者的十二指肠梗阻在三周内均得到缓解。其中1例患者的手术探查显示十二指肠明显水肿伴壁内血肿。其余5例患者有慢性梗阻病史。高营养治疗四周后梗阻仍未充分缓解，导致手术旁路。十二指肠活检标本显示有炎症、肌肉破坏和广泛纤维化。在25%的上消化道检查中发现十二指肠参与了中度重症胰腺炎的炎症过程，但通常是自限性的且程度较轻。由于相邻十二指肠水肿很常见，而纤维性胰十二指肠炎症仅偶尔发生在个别患者中，与胰腺炎相关的十二指肠梗阻的手术干预仅应在保守治疗失败得到证实后才考虑。
