- 期刊
Pancreas Divisum: An Infrequent Cause of Acute Pancreatitis in a Case
胰腺分裂症：急性胰臟炎之罕見原因之一病例報告
摘要
一無喝酒及服藥病史之四十歲女性，因持續性上腹疼痛四天入院，血清澱粉酵素及解脂酵素皆有上升情形，臨床診斷急性胰臟炎接受治療；腹部超音波顯示，總膽管大小正常，無膽結石，但胰臟有腫大及主胰管有輕微擴大現象；電腦斷層發現相同情形，且胰臟體部和尾部有浸潤及小量積液情形；因治療五天後，症狀仍未改善，故安排核磁共振膽胰道攝影術檢查(MRCP)，顯示胰臟腹側管並未顯影，背側管擴大且連接至副乳頭，診斷爲胰腺分裂症(Pancreas divisum, PD)。病患並末接受經內視鏡逆行性膽胰管攝影術(ERCP)及內視鏡治療術，經症狀和支持治療住院六天後出院；PD爲一先天性異常且可能誘發急性胰臟炎；必須有高度警覺性才能診斷PD，特別針對沒有喝酒、高血脂症或膽結石之年輕病患。雖然ERCP是最明確之診斷工具，但MRCP爲一非侵入性及高解析度之另一選擇工具；至於PD病患合併急性胰臟炎，是否需接受內視鏡治療，至今仍未有定論。
關鍵字
無資料並列摘要
A 40-year-old female without history of alcohol consumption and medication suffered from persistent epigastralgia for four days and was admitted to our hospital. Elevated serum amylase and lipase levels were noted. She was admitted and treated under the working diagnosis of acute pancreatitis. Abdominal sonography showed normal common bile duct, but enlargement of the whole pancreas and mild main pancreatic duct dilatation without evidence of gallstone. CT demonstrated consistent findings of mild infiltration around the pancreatic tail and body with minimal fluid collection without any space-occupying lesion. Due to persistent symptoms for five days, MRCP was arranged that showed non-opacification of the ventral duct and dilatation of the dorsal duct that drained into the minor papilla. Pancreas divisum (PD) was diagnosed. She was discharged after 6 days of hospitalization with symptomatic and supportive therapy without ERCP or endoscopic intervention. PD is a congenital anomaly predisposing to acute pancreatitis. The diagnosis of PD requires a high level of suspicion, especially in younger patients without evidence of alcohol consumption, hyperlipidemia, or gallstone. Although ERCP can give definite diagnosis, MRCP is the diagnostic tool of choice because of its noninvasiveness and high resolution. The justification of the use of invasive therapeutic measures in PD patients with pancreatitis is still controversial.
延伸閱讀
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