Wongpaitoon V, Kurathong S, Pekanan P
Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
J Med Assoc Thai. 1993 Aug;76(8):470-4.
A 19-year-old Thai male, who was a regular drinker, presented with massive ascites, back pain and leg edema for four months. On examination there was obvious clinical evidence of an inferior vena cava obstruction. Inferior vena cavography showed narrowing of the hepatic portion of IVC with collateral circulation. Surgical dilatation of the inferior vena cava was performed. The ascites were diagnosed four months later as pancreatic ascites with a very high ascitic amylase level. Computerised axial tomography and endoscopic retrograde pancreatography showed evidence of chronic calcific pancreatitis and pseudocyst. After further medical treatment, ascites and inferior vena cava stenosis subsided which was confirmed by repeated vena cavography, computerised axial tomography and magnetic resonance imaging. The cause of inferior vena cava stenosis and clinical obstruction in this case most likely resulted from phlebitis secondary to pancreatitis. The etiology of chronic calcific pancreatitis in this case might be alcoholic abuse and/or nutritional tropical pancreatitis. Inferior vena cava stenosis and associated pancreatic ascites complicating chronic calcific pancreatitis has not been previously reported in Thailand.
一名19岁的泰国男性，有长期饮酒习惯，因大量腹水、背痛和腿部水肿4个月前来就诊。检查发现有明显的下腔静脉阻塞临床证据。下腔静脉造影显示下腔静脉肝段狭窄并伴有侧支循环。对下腔静脉进行了手术扩张。4个月后腹水被诊断为胰源性腹水，腹水淀粉酶水平非常高。计算机断层扫描和内镜逆行胰胆管造影显示有慢性钙化性胰腺炎和假性囊肿的证据。经过进一步治疗，腹水和下腔静脉狭窄消退，这通过重复的腔静脉造影、计算机断层扫描和磁共振成像得到证实。该病例中下腔静脉狭窄和临床阻塞的原因很可能是胰腺炎继发的静脉炎。该病例中慢性钙化性胰腺炎的病因可能是酒精滥用和/或营养性热带胰腺炎。泰国此前尚未报道过慢性钙化性胰腺炎并发下腔静脉狭窄及相关胰源性腹水的情况。
