利用血管栓塞法治療胰臟炎之出血性偽動脈瘤－病例報告

Utilization of Transarterial Embolizat1on in the Management of Pancreatitis Induced Pseudoaneurysm Hemorrhage-A Case Report

石井宏(Hiroshi Ishii) ； 蔣咸嘉(Hsein-Jar Chiang) ； 周孫衍(Sun-Yen Chou) ； 黃倫奕(Lun-Yick Wong)

《中華放射線醫學雜誌》 12卷1期 (1987/03) Pp. 67-70

摘要

胰臟炎之發炎過程，會直接波及至動脈管壁，或由胰細胞破壞後所釋出的活性解蛋白酵素，直接地侵蝕到附近的動脈管壁，而形成了偽動脈瘤，此偽動脈瘤非常易於破裂，而造成威脅生命的消化道出血或腹膜腔內出血。我們經歷了一個慢性胰臟炎的病例，因形成脾動脈的偽動脈瘤而併發上消化道出血合併貧血現象。在病人第一次因上消化道出血住院檢查期間，雖作過胃十二指腸內視鏡檢查、上消化道及小腸鋇劑攝影、雙重對比鋇劑大腸攝影，及腹部電腦斷層攝影，均未能發現出血原因。而在第二次因上消化道出血住院時，經十二指腸內視鏡檢查及腹腔總動脈攝影術證實為脾動脈偽動脈瘤出血，爾後利用動脈栓塞法治療，成功的阻斷脾動脈而達到止血的目的。

並列摘要

In pancreatitis, either the inflammatory process directly invades the arterial wall or the destruction of pancreatic islet cells causing the release of proteolytic enzymes digesting the adjacent arterial wall which in turn developing into a pseudoaneurysm. This pseudoaneurysm ruptures easily causing massive upper gastrointestinal bleeding or intraabdominal hemorrhage.
We encountered a patient with chronic pancreatitis who presented with upper GI hemorrhage associated with anemia from splenic arterial pseudoaneurysm rupture.
On the first admission several diagnostic examinations were performed, such as gastroduodenoscopy, upper GI and small bowel series, double contrast colon series and abdominal CT scan. However, failed to locate the source of bleeding.
On the second admission, bleeding from ampulla Vater was found in scopy. Celiac angiography was performed which established a splenic arterial pseudoaneurysm. Subsequent selective splenic arterial embolization was performed, which successfully controlled the hemorrhage.