Wagner W H, Cossman D V, Treiman R L, Foran R F, Levin P M, Cohen J L
Division of Vascular Surgery, Cedars-Sinai Medical Center, Los Angeles, CA.
J Vasc Surg. 1994 Jan;19(1):158-64. doi: 10.1016/s0741-5214(94)70130-x.
Hemosuccus pancreaticus--blood entering the gastrointestinal tract through the pancreatic duct--is a rare and elusive form of gastrointestinal bleeding. The most common cause is a splenic artery pseudoaneurysm caused by acute or chronic inflammation of the pancreas. We report the case of an 86-year-old woman who had recurrent gastrointestinal bleeding from erosion of an aneurysm of the splenic artery into the pancreatic duct. The lack of associated symptoms, equivocal endoscopic findings, and the rarity of this entity resulted in a delay in diagnosis. Nonresective treatment by ligation of the splenic artery proximal and distal to the aneurysm prevented any additional bleeding. Postoperative technetium sulfur colloid scanning demonstrated normal perfusion of the spleen. Only 16 cases of hemosuccus pancreaticus from primary splenic artery disease have previously been reported in the English-language literature (15 primary aneurysms, one medial disruption without an aneurysm). In contrast to cases caused by inflammatory pseudoaneurysms, splenic artery-pancreatic duct fistulas caused by primary aneurysms of the splenic artery should be treated without pancreatic or splenic resection, either with surgery or by embolization. In elderly patients with recurrent gastrointestinal bleeding of obscure source, the differential diagnosis should include the possibility of a ruptured aneurysm communicating with a viscus.
胰源性消化道出血——血液通过胰管进入胃肠道——是一种罕见且难以捉摸的消化道出血形式。最常见的病因是由胰腺急慢性炎症引起的脾动脉假性动脉瘤。我们报告了一例86岁女性患者，其脾动脉动脉瘤侵蚀胰管导致反复消化道出血。由于缺乏相关症状、内镜检查结果不明确以及该病症的罕见性，导致诊断延迟。通过结扎动脉瘤近端和远端的脾动脉进行非切除治疗，防止了进一步出血。术后锝硫胶体扫描显示脾脏灌注正常。此前英文文献中仅报道过16例由原发性脾动脉疾病引起的胰源性消化道出血病例（15例原发性动脉瘤，1例无动脉瘤的中层破裂）。与炎症性假性动脉瘤引起的病例不同，由脾动脉原发性动脉瘤引起的脾动脉 - 胰管瘘应在不进行胰腺或脾脏切除的情况下进行治疗，可采用手术或栓塞治疗。对于来源不明的反复消化道出血的老年患者，鉴别诊断应包括动脉瘤破裂与脏器相通的可能性。
