- 期刊
Pancreatic Pseudocysts with Hemosuccus Pancreaticus Mimicking a Pancreatic Intraductal Papillary Mucinous Neoplasm: A Case Report
胰臟假性囊泡併胰血症以胰管內乳頭狀黏液性腫瘤表現：一病例報告
摘要
臨床上慢性胰臟炎常併發假性囊泡，但很難由影像和血液檢查去和惡性囊狀腫瘤鑑別診斷，而慢性胰臟炎併發胰血症更是罕見，我們報告一49歲男性有不明原因體重減輕，在電腦斷層和核磁共振影像表現為胰頭多葉性囊狀腫瘤併主胰管擴大，兩者間有較大交通管相連，因而診斷為胰臟管內乳突狀黏液性腫瘤，內視鏡檢查並發現鮮血由壺腹乳突流出而疑為膽血症，經手術切除後發現卻是慢性胰臟炎併發假性囊泡和胰血症，回顧文獻，影像上胰臟假性囊泡併胰血症以胰管內乳頭狀黏液性腫瘤非常罕見。
並列摘要
Intraductal papillary mucinous neoplasms (IPMNs) and hemosuccus pancreaticus are rare complications of chronic pancreatitis. We present a 49-year-old man who had a poor appetite and weight loss. The computedtomographic (CT) scans and magnetic resonance cholangiopancreatographic (MRCP) scans revealed dilatation of the main pancreatic duct (10 mm in diameter) and a large communicating duct (5 mm in diameter), a bulging papilla, and multilocular cystic tumors in the head and uncinate process of the pancreas; these represent the main criteria for diagnosing IPMNs. An endoscopic retrograde cholangiopancreatographic (ERCP) analysis showed active bleeding from the papilla of Vater. A Whipple operation was undertaken because the image appeared to be amalignant IPMN with potentially massive bleeding of hemobilia. Surprisingly, the cystic lesions of the pancreas were pseudocysts with hematomas and not cystic tumors. There were no blood clots in the specimen of the gallbladder and common bile duct, so the diagnosis of hemobilia was changed to hemosuccus pancreaticus (HP). It is unusual of an image of chronic pancreatitis with pseudocysts and HP to mimic a pancreatic IPMN.