消化管出血を来した膵仮性嚢胞の1例 A CASE OF PANCREATIC PSEUDOCYST WITH COLONIC PENETRATION

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症例は53歳,男性.30年来の大酒家であり慢性膵炎にて経過観察されていたが,突然の大量出血を来し緊急入院となった.腹部超音波検査・CT検査・消化管出血シンチグラフィーにて膵仮性嚢胞内出血の大腸穿通による下血と診断した.保存的治療にて一時的に改善したが,再度大量下血が認められたため手術を施行した.手術所見では,横行結腸を切開すると膵尾部の嚢胞との穿通が認められた.止血後,嚢胞を含めた膵尾部・脾・横行結腸合併切除を施行した.病理組織所見では,嚢胞壁の一部に動脈壁と穿通が認められた.術後,膵痩の治療に難渋したが軽快退院した.消化管出血を来す膵仮性嚢胞は予後不良症例が多く,治療は止血および外科的な嚢胞全摘が望ましいと考えられた.<br> 今回われわれは,消化管出血を来した膵仮性嚢胞の1例を経験したので,若干の文献的考察を加えて報告する.

A 53-year-old male patient, who had a history of 30 years of heavy intake of alcohol, admitted for sudden massive melena during observation for chronic pancreatitis. The patient was diagnosed by abdominal ultrasonic, CT examinations and photosyntigraphy of hemorrhage from the gastrointestinal tract as melena caused by colonic penetraction of intrapseudocystic hemorrhage of the pancreas. Conservative treatment provided temporary improvement, but the patient had another massive melena, for which operation was performed. Incision of the transverse colon revealed penetration with cyst in the pancreas tail. The pancreas tail including cyst, the spleen and the transverse colon were resected together. Histopathological examination revealed presence of arterial wall and penetration in part of cyst wall. The patient was relieved and discharged after treatment of intractable pancreatofistula. Most of hemorrhage from the gastrointestinal tract of pseudocyst of the pancreas have poor prognosis, we concluded that the treatment for this disease was hemostasis and surgical resection of whole pseudocyst of the pancreas.<br> A case of pseduocyst of the pancreas resulting with hemorrhage form the gastrointestinal tract is presented here with a review of literature.

収録刊行物

  • 日本臨床外科医学会雑誌 = The journal of the Japanese Practical Surgeon Society

    日本臨床外科医学会雑誌 = The journal of the Japanese Practical Surgeon Society 56(3), 605-609, 1995-03-25

    Japan Surgical Association

参考文献:  9件中 1-9件 を表示

被引用文献:  7件中 1-7件 を表示

各種コード

  • NII論文ID(NAID)
    10008512465
  • NII書誌ID(NCID)
    AN00198696
  • 本文言語コード
    JPN
  • 資料種別
    NOT
  • ISSN
    03869776
  • データ提供元
    CJP書誌  CJP引用  J-STAGE 
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