慢性胰臟炎併發假性囊腫囊內出血－病例報告

Bleeding Into the Pseudocyst Associated with Chronic Pancreatitis-A Case Report

大田生穗(Ikuho Ota) ； 蔣咸嘉(Hsein-Jar Chiang) ； 黃倫奕(Lun-Yick Wong)

《中華放射線醫學雜誌》 12卷1期 (1987/03) Pp. 71-74

摘要

慢性胰臟炎併發症當中最常見者為假性囊腫。而假性囊腫本身又可引發種種併發症。動脈性囊內出血是其中之一很多學者認為假性囊腫形成後隨著其體積增大壓迫附近的動脈，同時囊腫裡的蛋白酵素侵蝕附近的動脈壁而形成假性動脈瘤。一旦破裂出血時，有相當高的死亡率。為偵知其出血來源或被侵蝕的血管，血管攝影是不可或缺的檢查。經歷一位慢性胰臟炎併發假性囊腫囊內出血的病人，初步的腹腔動脈及胰背動脈血管攝影，無法偵知其出血來源，最後利用電腦斷層引導行經皮穿肝囊腫穿刺，並在透視下注入顯影劑後，發現出血源自胃左動脈。

並列摘要

The most common complication of chronic pancreatitis is pseudocyst formation which in turn various secondary complications such as bleeding.
In the process of enlarging, a pseudocyst incorporates adjacent vessels into its wall, forming pseudoaneurysm. These pseudoaneurysms are known to be caused by digestive activity of the proteolytic enzyme within the pseudocyst.
In the event of rupture, it carries a high mortality rate. Angiography is an indispensable tool in demonstrating bleeders or eroded vessels before operation or embolization.
In one of our patient, we performed celiac and selective dorsal pancreatic arteriography, however, no evidence of bleeder was found. Finally, CT guided transhepatic pseudocystic puncture was performed, the injected contrast medium was regurgitated into the left gastric artery.