von Flüe M, Kocher T, Herzog U, Looser C, Schuppisser J P
Chirurgische Klinik, St. Claraspital Basel.
Helv Chir Acta. 1993 Jun;59(5-6):785-9.
Bleeding pseudocysts respectively pseudoaneurysms represents a seldom complication of chronic pancreatitis in owing to erosion of pancreatic or peripancreatic arteries. The potential rupture into neighbouring organs or in the peritoneal cavity is accompanied with paramount life-threatening risks. During the last years we observed 3 patients with acute intestinal bleeding caused by pseudocysts converted to pseudoaneurysms. The goal of our report is to analyze the diagnostic tools and the management of patients with bleeding pancreatic pseudocysts, also well establish the clinical constellation, which is typical for this complication, the best diagnostic tool and the modalities to immediate control of the acute bleeding situation. All three patients suffered from chronic pancreatitis and alcohol abuse. The first patient had a known pancreatic pseudocyst, which penetrated through the gastric wall and caused a life-threatening bleeding. The second patient was admitted in owing to melena. The examinations yielded a pancreatic pseudocyst with hematosuccus pancreatis. The third patient suffered from abdominal pain and vertigo caused by anemia. With endoscopy, Cat and celiacography a pancreatic pseudocyst with cysto-colic fistula has been identified. The color-doppler ultrasound revealed a pseudoaneurysm supplied from a splenic artery branch. With management of these patients with hemorrhagic complications of pancreatic pseudocysts we acquired the following findings: 1. Patients with known chronic pancreatitis and abdominal tumor, especially when accompanied by epigastric pain and anemia, are highly suspicious for pancreatic pseudoaneurysms. 2. The color-doppler ultrasound is the best diagnostic tool, since this investigation can establish the pseudoaneurysm and identify the source.
出血性假性囊肿及假性动脉瘤是慢性胰腺炎罕见的并发症，系胰腺或胰周动脉受侵蚀所致。其可能破裂入邻近器官或腹腔，伴有极高的危及生命风险。过去几年，我们观察到3例由假性囊肿转变为假性动脉瘤导致急性肠道出血的患者。本报告的目的是分析出血性胰腺假性囊肿患者的诊断工具及治疗方法，明确该并发症典型的临床症状、最佳诊断工具以及立即控制急性出血情况的方式。所有3例患者均患有慢性胰腺炎且有酗酒史。首例患者有已知的胰腺假性囊肿，其穿透胃壁导致危及生命的出血。第二例患者因黑便入院。检查发现胰腺假性囊肿伴胰性血囊肿。第三例患者因贫血出现腹痛和眩晕。经内镜检查、CT及腹腔动脉造影，发现一个伴有囊肿 - 结肠瘘的胰腺假性囊肿。彩色多普勒超声显示一个由脾动脉分支供血的假性动脉瘤。通过对这些胰腺假性囊肿出血并发症患者的治疗，我们有以下发现：1. 已知患有慢性胰腺炎且有腹部肿物，尤其是伴有上腹部疼痛和贫血的患者，高度怀疑有胰腺假性动脉瘤。2. 彩色多普勒超声是最佳诊断工具，因为该检查可确定假性动脉瘤并明确其来源。
