Engler S, Dorlars D, Riemann J F
Medizinische Klinik C, Klinikum der Stadt Ludwigshafen.
Dtsch Med Wochenschr. 1996 Nov 8;121(45):1396-400. doi: 10.1055/s-2008-1043159.
A 45-year-old patient was admitted because of frequent attacks of upper abdominal pain after food intake. The pain episodes had started shortly after a bout of acute pancreatitis. Physical examination was unremarkable except for mild pain on palpation of the left lower abdomen.
Amylase and gamma-glutamyl transaminase activities as well as inflammatory parameters were slightly raised. Ultrasonography was suggestive of a circumscribed area of necrosis in the tail of the pancreas, a finding confirmed on endoscopic retrograde injection of contrast medium, which passed into the necrotic cavity via a fistula.
The fistula failed to close during 12 days of conservative treatment (total parenteral nutrition; 2 g ceftizoxim twice daily; 1 ampoule somatostatin daily). In three sittings during 6 days, 1-2 ml fibrin glue injections were made by endoscopy retrogradely into the fistular passage resulting in its complete occlusion without any further complications.
A previously treatment-resistant pancreatic fistula can be successfully occluded by injection of fibrin glue by retrograde endoscopy, obviating surgical intervention with subsequent reduction in glandular capacity.
一名45岁患者因进食后频繁出现上腹部疼痛而入院。疼痛发作在一次急性胰腺炎发作后不久开始。体格检查无异常，仅左下腹触诊时有轻度疼痛。
淀粉酶和γ-谷氨酰转肽酶活性以及炎症指标略有升高。超声检查提示胰腺尾部有一个局限性坏死区域，经内镜逆行注入造影剂证实了这一发现，造影剂通过瘘管进入坏死腔。
在12天的保守治疗（全胃肠外营养；每日两次2克头孢唑肟；每日1支生长抑素）期间，瘘管未能闭合。在6天内分三次通过内镜逆行向瘘管通道注射1 - 2毫升纤维蛋白胶，使其完全闭塞，未出现任何进一步并发症。
通过逆行内镜注射纤维蛋白胶可成功闭塞先前治疗抵抗的胰瘘，避免手术干预及随后腺体功能的降低。
