Allgaier H P, Blum U, Haag K, Flügel P, Schwacha H, Langer M, Blum H E
Abteilung Innere Medizin II, Medizinische Universitätsklinik, Freiburg.
Dtsch Med Wochenschr. 1996 Sep 20;121(38):1158-62. doi: 10.1055/s-2008-1043120.
Two patients were admitted to hospital for diagnosis of recurrent upper gastrointestinal bleeding. Both had chronic pancreatitis with alcohol abuse. Their general condition was satisfactory. Physical examination showed no diagnostic abnormalities other than mild epigastric pain on pressure in one patient.
In case 1 angiography revealed pseudoaneurysm of the splenic artery as a complication of chronic pancreatitis to be the cause of the bleeding. In case 2 sonography demonstrated multiple pancreatic pseudocysts after recurrent pancreatitis. Duplex sonography revealed one of the cyst to be a partly thrombosed pseudoaneurysm of the splenic artery and the source of the bleeding.
In both cases a fistula between splenic artery and pancreatic duct having been shown to be the source of the bleeding, transcatheter embolisation of the splenic artery with platinum coils was successfully undertaken. Both patients remained symptom-free 4 and 10 months later.
Although haemosuccus pancreaticus is a rare cause of upper gastrointestinal bleeding, given certain features in the patient's history and the clinical findings, it should be included in the differential diagnosis.
两名患者因复发性上消化道出血入院诊断。两人均患有慢性胰腺炎且有酗酒史。他们的一般状况良好。体格检查显示，除一名患者上腹部轻压痛外，无其他诊断异常。
病例1血管造影显示脾动脉假性动脉瘤是慢性胰腺炎的并发症，为出血原因。病例2超声检查显示复发性胰腺炎后有多个胰腺假性囊肿。双功超声显示其中一个囊肿为脾动脉部分血栓形成的假性动脉瘤，是出血来源。
在两例中，均已证明脾动脉与胰管之间的瘘是出血来源，成功地用铂金线圈对脾动脉进行了经导管栓塞。4个月和10个月后，两名患者均无症状。
尽管胰性出血是上消化道出血的罕见原因，但鉴于患者病史和临床发现的某些特征，应将其纳入鉴别诊断。
