Pseudoaneurysmata viszeraler Gefäße als Komplikation der chronischen Pankreatitis, eine seltene Ursache der gastrointestinalen Blutung

Zusammenfassung

Wir berichten über einen Patienten mit chro­nischer Pankreatitis äthyltoxischer Genese mit bekannten Pseudozysten und rezidivierenden linksseitigen Oberbauchschmerzen, der wegen einer unklar gebliebenen oberen gastrointesti­nalen Blutung vorgestellt wird. Mittels zunächst ­orthograder Endoskopie des oberen Gastrointestinaltraktes (ÖGD) und anschließend Papillen­inspektion mittels Seitblickoptik (ERCP) findet sich eine kinderfaustgroße Impression der Magenhinterwand. Es zeigt sich ein Blutaustritt aus der Papilla Vateri (Haemosuccus pancreaticus). Nach selektiver Intubation des D. Wirsungianus wird eine inkomplette Stenose des D. Wirsun­gianus im Korpusbereich nachgewiesen. Die größte der Pseudozysten kommuniziert mit dem Pan­kreasgang. Farbduplexsonografisch und an­gio­grafisch wird die Diagnose einer arteriell einblutenden Pankreaspseudozyste bestätigt. Anschließend wird der Patient laparotomiert und eine totale Gastrektomie, Splenektomie und Pan­kreaslinksresektion durchgeführt.

Abstract

Hemorrhage into pancreatic pseudocysts is a known complication of chronic pancreatitis. ­Direct hemorrhage into the pancreatic duct is a rare entity, described first by Lower and Farrell [1], and only a few cases have been reported so far. The term “hemosuccus pancreaticus” was first used by Sandblom [2]. Hemosuccus pancreaticus is often accompanied by epigastric pain, attacks of gastrointestinal hemorrhage with consecutive anemia, shock and sometimes with symptoms of hemobilia. Patients with splenic artery aneurysm and hemosuccus pancraticus present most often with the symptoms of the underlying disease, e. g., (chronic) pancreatitis. We report on two ­cases with different diagnostic and therapeutic man­agement which reflect changes over time.

Schlüsselwörter

gastrointestinale Blutung - chronische Pankreatitis - Pseudoaneurysma - viszerale Gefäße - Haemosuccus pancreaticus - Pseudozysten

Key words

gastrointestinal bleeding - chronic pancreatitis - pseudoaneurysm - visceral vessels - hemosuccus pancreaticus - pseudocysts

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