- 期刊
Hepatic Artery Pseudoaneurysm Presenting as a Bleeding Duodenal Submucosal Tumor
以十二指腸黏膜下腫瘤併出血之肝動脈假性動脈瘤
摘要
我們發表一個與腹部創傷病史有關的肝動脈假性動脈瘤(pseudoaneurysm)之四十七歲男性病例，此假性動脈瘤以十二指腸黏膜下腫瘤併黏膜出血表現。當我們執行緊急內視鏡腎上腺素局部注射止血後幸運地並未造成其破裂，之後的都卜勒超音波檢查顯示這是一個中心區域有脈動血流的6.5×4.0公分的低回音腫瘤，而電腦斷層檢查也發現有一個5.4×3.2公分的假性動脈瘤位於膽囊與胰臟頭之間，血管攝影檢查進一步確認了此假性動脈瘤來自於總肝動脈。我們回顧了文獻上關於肝動脈假性動脈瘤的成因與臨床表現，這是第一個以十二指腸黏膜下腫瘤併黏膜出血表現的病例，故當我們診斷一個十二指腸黏膜下腫瘤時，應將肝動脈假性動脈瘤列入鑑別診斷。
並列摘要
Background and Purpose: Hepatic artery pseudoaneurysm is rare and most cases are of iatrogenic or traumatic origin. It may present with upper gastrointestinal bleeding if hemobilia or pseudoaneurysm-duodenal fistula are formed. Methods: We describe a 47-year-old male patient suffering from hepatic artery pseudoaneurysm associated with remote blunt abdominal trauma. The pseudoaneurysm mimicked a duodenal submucosal tumor with mucosal bleeding on emergent panendoscopy. Fortunately, rupture of the hepatic artery pseudoaneurysm was not complicated by the local epinephrine injection therapy given for hemostasis. Results: Subsequent color Doppler ultrasonography revealed a pulsatile wave pattern in the central area of a 6.5×4.0 cm hypoechoic tumor. Computed tomography demonstrated a 5.4×3.2 cm pseudoaneurysm between the gallbladder and the pancreatic head. Angiography confirmed that the origin of the pseudoaneurysm was the common hepatic artery. Conclusion: We reviewed the etiologies and clinical manifestations of hepatic artery pseudoaneurysm in the literature and believe this is the first case of hepatic artery pseudoaneurysm that presented as a duodenal submucosal tumor with mucosal bleeding. We should take hepatic artery pseudoaneurysm into consideration when a duodenal submucosal tumor is diagnosed.