Ammori B J, Madan M, Alexander D J
Department of Surgery, York District Hospital.
Ann R Coll Surg Engl. 1998 Sep;80(5):316-25.
Massive haemorrhage is an uncommon complication in pancreatitis. Most affected patients suffer from chronic disease with associated pseudocyst. We present five patients (four male) with a mean age of 41 years (range 34-48 years). All patients had alcohol-induced pancreatitis complicated either by haematemesis (3), intraperitoneal haemorrhage (1) or both haematemesis and intraperitoneal haemorrhage (1). Source of bleeding was pseudocyst wall (2), splenic artery pseudoaneurysm (2) and splenic artery rupture (1). Distal pancreatectomy and splenectomy was performed in two patients, intracystic ligation and drainage in two, and packing with subsequent external drainage in one. Rebleeding occurred in two patients and required subsequent distal pancreatectomy and splenectomy in one; the other patient died of splenic rupture. No rebleeding and no mortality occurred after resection. Primary pancreatic resection is recommended whenever possible. Other management options include embolisation and ligation.
大出血是胰腺炎中一种罕见的并发症。大多数受影响的患者患有慢性疾病并伴有假性囊肿。我们报告了5例患者（4例男性），平均年龄41岁（范围34 - 48岁）。所有患者均患有酒精性胰腺炎，并发呕血（3例）、腹腔内出血（1例）或呕血与腹腔内出血同时存在（1例）。出血来源为假性囊肿壁（2例）、脾动脉假性动脉瘤（2例）和脾动脉破裂（1例）。2例患者接受了胰体尾切除术和脾切除术，2例进行了囊内结扎和引流，1例进行了填塞并随后进行了外引流。2例患者发生再出血，其中1例随后需要进行胰体尾切除术和脾切除术；另1例患者死于脾破裂。切除术后未发生再出血且无死亡病例。只要有可能，建议进行胰腺一期切除术。其他治疗选择包括栓塞和结扎。
