A Case of a Hemorrhagic Pancreatic Pseudocyst
A 69-year-old man was transferred to our hospital for the treatment of pulmonary tuberculosis. At admission, abdominal computed tomography showed right renal cancer and chronic pancreatitis with a pancreatic pseudocyst and pancreatolithiasis. After 4 months of therapy for the pulmonary tuberculosis,...
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| Published in | Nihon Fukubu Kyukyu Igakkai Zasshi (Journal of Abdominal Emergency Medicine) Vol. 39; no. 4; pp. 797 - 800 |
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| Main Authors | , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
Japanese Society for Abdominal Emergency Medicine
31.05.2019
日本腹部救急医学会 |
| Subjects | |
| Online Access | Get full text |
| ISSN | 1340-2242 1882-4781 |
| DOI | 10.11231/jaem.39.797 |
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| Abstract | A 69-year-old man was transferred to our hospital for the treatment of pulmonary tuberculosis. At admission, abdominal computed tomography showed right renal cancer and chronic pancreatitis with a pancreatic pseudocyst and pancreatolithiasis. After 4 months of therapy for the pulmonary tuberculosis, a right nephrectomy was performed for the renal cancer. Two months postoperatively, the patient complained of increasing intermittent abdominal pain that had lasted for a month. Abdominal CT revealed acute on chronic pancreatitis and a hemorrhagic pancreatic pseudocyst. Gastroduodenoscopy showed hemosuccus pancreaticus, which is bleeding from the ampulla of Vater via the pancreatic duct. Abdominal angiography demonstrated extravasation into the pancreatic pseudocyst from the arterial branches to the gastric lesser curvature from the left and right gastric arteries, and those branches were embolized. Ten months after the arterial embolization, the intracystic bleeding relapsed. The bleeding subsequently ceased and an elective distal pancreatectomy was performed for the pseudocyst. The patient was discharged 19 days after surgery and has been alive for 30 months since the distal pancreatectomy, without recurrence of the pancreatitis or pancreatic pseudocyst. |
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| AbstractList | A 69-year-old man was transferred to our hospital for the treatment of pulmonary tuberculosis. At admission, abdominal computed tomography showed right renal cancer and chronic pancreatitis with a pancreatic pseudocyst and pancreatolithiasis. After 4 months of therapy for the pulmonary tuberculosis, a right nephrectomy was performed for the renal cancer. Two months postoperatively, the patient complained of increasing intermittent abdominal pain that had lasted for a month. Abdominal CT revealed acute on chronic pancreatitis and a hemorrhagic pancreatic pseudocyst. Gastroduodenoscopy showed hemosuccus pancreaticus, which is bleeding from the ampulla of Vater via the pancreatic duct. Abdominal angiography demonstrated extravasation into the pancreatic pseudocyst from the arterial branches to the gastric lesser curvature from the left and right gastric arteries, and those branches were embolized. Ten months after the arterial embolization, the intracystic bleeding relapsed. The bleeding subsequently ceased and an elective distal pancreatectomy was performed for the pseudocyst. The patient was discharged 19 days after surgery and has been alive for 30 months since the distal pancreatectomy, without recurrence of the pancreatitis or pancreatic pseudocyst.
症例は69歳，男性。肺結核の治療目的に当院紹介。入院時のCT検査で右腎癌および膵石と膵仮性囊胞を伴う慢性膵炎が指摘された。4ヵ月間の肺結核の治療ののち，右腎癌に対して右腎摘出術が行われた。術1ヵ月後頃より上腹部痛を自覚し，徐々に疼痛の増強と嘔吐を認め，術2ヵ月後に当院に救急搬送された。来院時の腹部CT検査で，慢性膵炎の急性増悪と膵仮性囊胞内出血が疑われた。入院後の上部消化管内視鏡検査で，十二指腸乳頭から流出する胆汁・膵液に血液の混在（hemosuccus pancreaticus）が認められた。腹部血管造影検査で右胃動脈および左胃動脈の胃小弯への分枝から囊胞内への出血が確認され，これらの動脈枝の塞栓術が施行された。動脈塞栓術10ヵ月後に膵仮性囊胞内出血の再発が疑われたが，出血は活動性ではなく，待機的に膵体尾部切除術が施行され，術19日後に軽快退院した。膵切除術30ヵ月後の現在，膵炎や膵仮性囊胞の再発は認めていない。 A 69-year-old man was transferred to our hospital for the treatment of pulmonary tuberculosis. At admission, abdominal computed tomography showed right renal cancer and chronic pancreatitis with a pancreatic pseudocyst and pancreatolithiasis. After 4 months of therapy for the pulmonary tuberculosis, a right nephrectomy was performed for the renal cancer. Two months postoperatively, the patient complained of increasing intermittent abdominal pain that had lasted for a month. Abdominal CT revealed acute on chronic pancreatitis and a hemorrhagic pancreatic pseudocyst. Gastroduodenoscopy showed hemosuccus pancreaticus, which is bleeding from the ampulla of Vater via the pancreatic duct. Abdominal angiography demonstrated extravasation into the pancreatic pseudocyst from the arterial branches to the gastric lesser curvature from the left and right gastric arteries, and those branches were embolized. Ten months after the arterial embolization, the intracystic bleeding relapsed. The bleeding subsequently ceased and an elective distal pancreatectomy was performed for the pseudocyst. The patient was discharged 19 days after surgery and has been alive for 30 months since the distal pancreatectomy, without recurrence of the pancreatitis or pancreatic pseudocyst. |
| Author | Tsukamoto, Tadashi Togano, Shingo Kaizaki, Ryoji Yamaguchi, Seiko Hori, Takaaki Takatsuka, Satoshi Edagawa, Eijiro |
| Author_FL | 堀 高明 山口 誓子 栂野 慎吾 枝川 永二郎 貝崎 亮二 高塚 聡 塚本 忠司 |
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| Author_xml | – sequence: 1 fullname: Edagawa, Eijiro organization: Department of Surgery, Osaka City Juso Hospital – sequence: 1 fullname: Hori, Takaaki organization: Department of Surgery, Osaka City Juso Hospital – sequence: 1 fullname: Yamaguchi, Seiko organization: Department of Gastroenterology, Osaka City Juso Hospital – sequence: 1 fullname: Tsukamoto, Tadashi organization: Department of Surgery, Osaka City Juso Hospital – sequence: 1 fullname: Togano, Shingo organization: Department of Surgery, Osaka City Juso Hospital – sequence: 1 fullname: Takatsuka, Satoshi organization: Department of Surgery, Osaka City Juso Hospital – sequence: 1 fullname: Kaizaki, Ryoji organization: Department of Surgery, Osaka City Juso Hospital |
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| References | 9) Stabile BE, Wilson SE, Debas HT: Reduced mortality from bleeding pseudocysts and pseudoaneurysms caused by pancreatitis. Arch Surg 1983; 118: 45-51. 11) Boudghène F, L’Herminè C, Bigot JM: Arterial complications of pancreatitis: diagnostic and therapeutic aspects in 104 cases. J Vasc Interv Radiol 1993; 4: 551-558. 8) Yokoe M, Takada T, Mayumi T, et al: Japanese guidelines for the management of acute pancreatitis: Japanese guidelines 2015. J Hepatobiliary Pancreat Sci 2015; 22: 405-432. 6) Williams KJ, Fabian TC: Pancreatic pseudocyst: recommendations for operative and nonoperative management. Am Surg 1992; 58: 199-205. 2) 乾 和郎，入澤篤志，大原弘隆，ほか：膵仮性嚢胞の内視鏡治療ガイドライン2009．膵臓2009；24：571-593. 10) 栗栖美由希，石神智行，中川彰彦，ほか：膵仮性嚢胞内出血，大腸穿破に対して塞栓術で治癒した一例．日本救急医学会中部地方会誌2016；12：40-42. 4) Bradley ELⅢ, Clements JL Jr, Gonzalez AC: The natural history of pancreatic pseudocysts: a unified concept of management. Am J Surg 1979; 137: 135-141. 5) Cui ML, Kim KH, Kim HG, et al: Incidence, risk factors and clinical course of pancreatic fluid collections in acute pancreatitis. Dig Dis Sci 2014; 59: 1055-1062. 1) 厚生労働省科学研究費補助金難治性疾患克服研究事業 難治性膵疾患に関する調査研究班：膵炎局所合併症（膵仮性嚢胞,感染性被包化壊死等）に対する診断・治療コンセンサス．膵臓2014；29：775-818. 3) Banks PA, Bollen TL, Dervenis C, et al: Acute Pancreatitis Classification Working Group. Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus. Gut 2013; 62: 102-111. 7) Yeo CJ, Bastidas JA, Lynch-Nyhan A, et al: The natural history of pancreatic pseudocysts documented by computed tomography. Surg Gynecol Obstet 1990; 170: 411-417. |
| References_xml | – reference: 7) Yeo CJ, Bastidas JA, Lynch-Nyhan A, et al: The natural history of pancreatic pseudocysts documented by computed tomography. Surg Gynecol Obstet 1990; 170: 411-417. – reference: 1) 厚生労働省科学研究費補助金難治性疾患克服研究事業 難治性膵疾患に関する調査研究班：膵炎局所合併症（膵仮性嚢胞,感染性被包化壊死等）に対する診断・治療コンセンサス．膵臓2014；29：775-818. – reference: 9) Stabile BE, Wilson SE, Debas HT: Reduced mortality from bleeding pseudocysts and pseudoaneurysms caused by pancreatitis. Arch Surg 1983; 118: 45-51. – reference: 8) Yokoe M, Takada T, Mayumi T, et al: Japanese guidelines for the management of acute pancreatitis: Japanese guidelines 2015. J Hepatobiliary Pancreat Sci 2015; 22: 405-432. – reference: 10) 栗栖美由希，石神智行，中川彰彦，ほか：膵仮性嚢胞内出血，大腸穿破に対して塞栓術で治癒した一例．日本救急医学会中部地方会誌2016；12：40-42. – reference: 5) Cui ML, Kim KH, Kim HG, et al: Incidence, risk factors and clinical course of pancreatic fluid collections in acute pancreatitis. Dig Dis Sci 2014; 59: 1055-1062. – reference: 11) Boudghène F, L’Herminè C, Bigot JM: Arterial complications of pancreatitis: diagnostic and therapeutic aspects in 104 cases. J Vasc Interv Radiol 1993; 4: 551-558. – reference: 2) 乾 和郎，入澤篤志，大原弘隆，ほか：膵仮性嚢胞の内視鏡治療ガイドライン2009．膵臓2009；24：571-593. – reference: 3) Banks PA, Bollen TL, Dervenis C, et al: Acute Pancreatitis Classification Working Group. Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus. Gut 2013; 62: 102-111. – reference: 6) Williams KJ, Fabian TC: Pancreatic pseudocyst: recommendations for operative and nonoperative management. Am Surg 1992; 58: 199-205. – reference: 4) Bradley ELⅢ, Clements JL Jr, Gonzalez AC: The natural history of pancreatic pseudocysts: a unified concept of management. Am J Surg 1979; 137: 135-141. |
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| SubjectTerms | hemosuccus pancreaticus 動脈塞栓術 動脈瘤 膵炎 |
| Title | A Case of a Hemorrhagic Pancreatic Pseudocyst |
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