The Korean Journal of Medicine

  • 제82권6호
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  • Pages.713-717
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  • 2012
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  • 1738-9364(pISSN)
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  • 2289-0769(eISSN)
대한내과학회 (The Korean Association of Internal Medicine)
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십이지장 출혈로 발현한 췌장 가성낭종 1예

A Case of Pancreatic Pseudocyst Presenting as Duodenal Bleeding

  • 이정화 (가톨릭대학교 의과대학 대전성모병원 내과) ;
  • 권기현 (가톨릭대학교 의과대학 대전성모병원 내과) ;
  • 하동천 (가톨릭대학교 의과대학 대전성모병원 내과) ;
  • 김보경 (가톨릭대학교 의과대학 대전성모병원 내과) ;
  • 정승혜 (가톨릭대학교 의과대학 대전성모병원 내과) ;
  • 김연수 (가톨릭대학교 의과대학 대전성모병원 내과) ;
  • 이동수 (가톨릭대학교 의과대학 대전성모병원 내과)
  • Lee, Jeong-Hwa (Department of Internal Medicine, Daejeon St. Mary's Hospital, The Catholic University of Korea College of Medicine) ;
  • Kwon, Ki-Hyun (Department of Internal Medicine, Daejeon St. Mary's Hospital, The Catholic University of Korea College of Medicine) ;
  • Ha, Dong-Cheon (Department of Internal Medicine, Daejeon St. Mary's Hospital, The Catholic University of Korea College of Medicine) ;
  • Kim, Bo-Kyoung (Department of Internal Medicine, Daejeon St. Mary's Hospital, The Catholic University of Korea College of Medicine) ;
  • Jung, Seung-Hye (Department of Internal Medicine, Daejeon St. Mary's Hospital, The Catholic University of Korea College of Medicine) ;
  • Kim, Yeon-Soo (Department of Internal Medicine, Daejeon St. Mary's Hospital, The Catholic University of Korea College of Medicine) ;
  • Lee, Dong-Soo (Department of Internal Medicine, Daejeon St. Mary's Hospital, The Catholic University of Korea College of Medicine)
  • 발행 : 2012.06.01
⟨ 이전 논문 다음 논문 ⟩

초록

췌장의 가성낭종은 췌장염에 의하여 흔히 발생하는 합병증으로 대개 췌장 내부나 췌장의 주위조직에 발생한다. 합병증으로는 감염, 주위내장이나 복강 내로의 파열, 누공, 장관폐쇄, 출혈 등이 발생하며, 가성낭종에 의한 출혈은 상부위장관 출혈의 드문 원인중의 하나이지만, 위험한 합병증이다. 저자들은 혈변을 주소로 내원한 만성 췌장염 환자에서 십이지장 점막하종양 출혈로 오인하였다가 췌장 가성낭종이 십이지장의 유두부를 침범하여 이로 인해 유발된 상부위장관 출혈로 진단하였으며, 보존적 치료로 호전된 1예를 경험하였기에 보고하고자 한다.

Pancreatic pseudocysts occur following acute pancreatitis, chronic pancreatitis or secondary to pancreatic trauma. Most pancreatic pseudocysts are located in or around the pancreas, but they can be found in all the potential spaces around viscera in and outside of the abdominal cavity. The complications of pancreatic pseudocyst are infection, rupture, obstruction, fistula, or hemorrhage. Hemorrhage is a rare but frequently fatal complication of pancreatic pseudocysts. We report a case of pancreatic pseudocyst presented as bleeding of duodenum, which was misidentified for duodenal submucosal tumor bleeding.

키워드

참고문헌

  1. Warshaw AL. Pancreatic cysts and pseudocysts: new rules for a new game. Br J Surg 1989;76:533-534. https://doi.org/10.1002/bjs.1800760603
  2. Imrie CW, Buist LJ, Shearer MG. Importance of cause in the outcome of pancreatic pseudocysts. Am J Surg 1988;156(3 Pt 1):159-162. https://doi.org/10.1016/S0002-9610(88)80055-2
  3. Boerma D, Obertop H, Gouma DJ. Pancreatic pseudocysts in chronic pancreatitis: surgical or interventional drainage? Ann Ital Chir 2000;71:43-50.
  4. Pitchumoni CS, Agarwal N. Pancreatic pseudocysts: when and how should drainage be performed? Gastroenterol Clin North Am 1999;28:615-639. https://doi.org/10.1016/S0889-8553(05)70077-7
  5. Walt AJ, Bouwman DL, Weaver DW, Sachs RJ. The impact of technology on the management of pancreatic pseudocyst: fifth annual Samuel Jason Mixter Lecture. Arch Surg 1990;125: 759-763. https://doi.org/10.1001/archsurg.1990.01410180085014
  6. Grendell JH, Cello JP. Chronic pancreatitis. In: Sleisenger MH, Fordtran JS, eds. Gastrointestinal Disease: Pathophysiology, Diagnosis, Management. 4th ed. Philadelphia: WB Saunders, 1989:1842-1872.
  7. Habashi S, Draganov PV. Pancreatic pseudocyst. World J Gastroenterol 2009;15:38-47. https://doi.org/10.3748/wjg.15.38
  8. Jarmockik P, Banaszkiewicz Z, Swiatkiekiewicz A, Jawien A. Intracystic bleeding in course of pancreatic pseudocyst: case study. Gastroenterol Pol 2000;7:225-227.
  9. Bradley EL 3rd. A clinically based classification system for acute pancreatitis: summary of the International symposium on acute pancreatitis, Atlanta, Ga, September 11 through 13, 1992. Arch Surg 1993;128:586-590. https://doi.org/10.1001/archsurg.1993.01420170122019
  10. You CR, Shin SW, Lee BI, et al. Upper gastrointestinal hemorrhage from pancreatic pseudocyst involving the duodenum: a case report. Korean J Gastrointest Endosc 2004;29:217-221.
  11. Kim YH, Seo CH. Treatment of an intrahepatic pseudocyst induced by acute aggravation of chronic pancreatitis. Korean J Med 2009;77(Suppl 2):S306-S310.
  12. Bellon EM, George CR, Schreiber H, Marshall JB. Pancreatic pseudocysts of the duodenum. AJR Am J Roentgenol 1979;133: 827-831. https://doi.org/10.2214/ajr.133.5.827
  13. Boulanger S, Volpe CM, Ullah A, Lindfield V, Doerr R. Pancreatic pseudocyst with biliary fistula: treatment with endoscopic internal drainage. South Med J 2001;94:347-349. https://doi.org/10.1097/00007611-200194030-00016
  14. Tanaka A, Takeda R, Utsunomiya H, Kataoka M, Mukaihara S, Hayakawa K. Severe complications of mediastinal pancreatic pseudocyst: report of esophagobronchial fistula and haemothorax. J Hepatobiliary Pancreat Surg 2000;7:86-91. https://doi.org/10.1007/s005340050159
  15. Flati G, Salvatori F, Porowska B, et al. Severe hemorrhagic complications in pancreatitis. Ann Ital Chir 1995;66:233-237.
  16. Van Rooyen W, van Blankenstein M, Eeftinck Schattenkerk M, et al. Haemorrhage from the pancreatic duct: a rare form of upper gastrointestinal bleeding. Br J Surg 1984;71:137-140. https://doi.org/10.1002/bjs.1800710220
  17. Triller J, Seiler C, Blumgart LH. Acute intestinal haemorrhage in a pancreatic pseudocyst-colic fistula. Rofo 1989;151:527-531. https://doi.org/10.1055/s-2008-1047234
  18. Yoon YB, Kim TH, Sheen GS, Kim YT, Kim CY. Conservative treatment of pancreatic pseudocyst. Korean J Med 1996;51: 373-379.
  19. Aghdassi A, Mayerle J, Kraft M, Sielenkämper AW, Heidecke CD, Lerch MM. Diagnosis and treatment of pancreatic pseudocysts in chronic pancreatitis. Pancreas 2008;36:105-112. Erratum in: Pancreas 2008;37:240. https://doi.org/10.1097/MPA.0b013e31815a8887
  20. Kim KJ, Kim GG, Kim HJ, et al. A case of an enlarged pancreatic pseudocyst treated with percutaneous transgastric catheter drainage. Korean J Med 1990;38:830-834.