Hwang Y T, Chen C H, Wang H P, Yang P M, Yu S C, Wu C T, Wang T H, Lin J T
Departments of Internal Medicine, National Taiwan University Hospital, Taipei.
J Formos Med Assoc. 1996 Mar;95(3):247-51.
Hemorrhage through the pancreatic duct into the duodenum, so called "hemosuccus pancreaticus", is a rare cause of gastrointestinal bleeding with diagnostic difficulties. We report a 60-year-old man with recurrent upper gastrointestinal bleeding due to rupture of a splenic artery pseudoaneurysm into the pancreatic duct. Initial upper gastrointestinal endoscopy failed to identify the site of the hemorrhage. Abdominal computed tomography disclosed a cystic mass containing a well-enhanced spherical area at the pancreatic tail. Arterial blood flow was demonstrated in the lesion by Doppler ultrasound. Celiac angiography demonstrated a saccular pseudoaneurysm arising from the splenic artery. Bleeding from the ampulla of Vater located in a big duodenal diverticulum was found on repeat endoscopy. Surgical resection of the pseudoaneurysm with distal pancreatectomy and splenectomy was successfully performed. The patient remained symptom-free 5 months after the operation. Hemosuccus pancreaticus, although rare, remains important in the differential diagnosis of upper gastrointestinal bleeding of obscure origin.
胰管出血进入十二指肠，即所谓的“胰源性出血”，是一种罕见的胃肠道出血原因，诊断困难。我们报告一名60岁男性，因脾动脉假性动脉瘤破裂进入胰管而反复出现上消化道出血。最初的上消化道内镜检查未能确定出血部位。腹部计算机断层扫描显示胰腺尾部有一个囊性肿块，内有一个强化良好的球形区域。多普勒超声显示病变处有动脉血流。腹腔动脉造影显示脾动脉有一个囊状假性动脉瘤。再次内镜检查发现位于一个大的十二指肠憩室内的 Vater壶腹出血。成功地进行了假性动脉瘤切除并远端胰腺切除术和脾切除术。术后5个月患者无症状。胰源性出血虽然罕见，但在不明原因的上消化道出血的鉴别诊断中仍然很重要。
