- 期刊
Management of Bleeding Pseudoaneurysm with Arterial Embolization in ERCP-related Pancreatitis: Report of a Case
以動脈栓塞治療因內視鏡逆行性膽道胰管攝影併發胰臟炎所造成的偽動脈瘤出血：病例報告
摘要
胰臟附近的偽動脈瘤的形成是由於胰臟酵素侵犯胰臟或胰臟周圍的動脈或是偽性囊腫侵蝕鄰近的內臟動脈。處理偽動脈瘤的出血對臨床醫師而言仍是件極具挑戰的工作，因為它伴隨著高死亡率。本篇報告一位54歲男性，因接受內視鏡逆行性膽道胰管攝影檢查併發急性胰臟炎。他接受積極內科治療，但發燒與腹痛持續3周，於是在胰臟壞死合併膿瘍的診斷下接受剖腹手術。手術時發現右上腹內有大量血塊與組織滲血，而且合併十二指腸的漿膜層的損傷。偽動脈瘤出血在術後的動脈攝影中獲得診斷，同時成功地以動脈栓塞的方式治療；十二指腸的損傷則藉由幽門關閉與後續的胃空腸造口術獲得治癒。病患於第一次手術後第33天出院，在往後的24個月的追蹤當中，並無偽動脈瘤再出血或其它併發症的發生。
關鍵字
無資料並列摘要
Peripancreatic pseudoaneurysms result either from enzymatic insult to pancreatic and peripancreatic arteries or from erosion of a pseudocyst into adjacent visceral arteries. A Peripancreatic pseudoaneurysms result either from enzymatic insult to pancreatic and peripancreatic arteries or from erosion of a pseudocyst into adjacent visceral arteries. A bleeding pseudoaneurysm is a rare complication of acute pancreatitis, and management of bleeding pseudoaneurysms is still a challenge for clinicians because it is associated with a high mortality rate. We here report on a 54-year-old male patient suffering from acute pancreatitis related to endoscopic retrograde cholangiopancreatography. He received aggressive medical treatment, since persistent fever and abdominal pain were identified for 3 weeks. Laparotomy was performed under the impression of pancreatic necrosis and abscess. During the operation, much fresh and clotted blood was found to have accumulated in the right subphrenic space and Morison's pouch. Active oozing and a circumferential seromuscular tear in the second-portion of the duodenum were identified. The bleeding pseudoaneurysm was identified postoperatively by means of angiography and was successfully treated with arterial embolization. Pyloric exclusion and subsequent gastrojejunostomy were performed to treat the duodenal injury. The patient was discharged home on the 33rd day after the first surgery with no evidence of rebleeding or sequelae over the following 24 months.
延伸閱讀
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