Management of the late effects of disconnected pancreatic duct syndrome: A case report
Management of the late effects of disconnected pancreatic duct syndrome: A case report
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DOI：
10.12998/wjcc.v7.i9.1053
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发表时间：
2019-05-06
影响因子：
1.1
通讯作者：
Takei, Yoshiyuki
中科院分区：
文献类型：
--
作者：
Yamada, Reiko;Umeda, Yuhei;Takei, Yoshiyuki
背景关于胰管断离综合征（DPDS）的晚期效应的报道很少。虽然很少有报道描述胰腺炎的复发间隔，但超过5年后复发的可能很少见。在此，我们描述了一个81岁的男子治疗后复发的情况下，围壁坏死（WON）与胰腺横断7 years ago.CASE SUMMARYan 81岁的男子来到我们医院的主要投诉发烧和腹痛7年后，由于严重的坏死性胰腺炎WON发病。他的病史包括腹主动脉瘤（AAA）、高血压、血脂异常和慢性肾脏疾病。计算机断层扫描（CT）显示，胰液积聚（PFC）已扩散至主动脉，周围有炎症，CT结果表明，由于脾静脉闭塞导致血管扩张而发生出血。首先，由于残胃和PFC周围的静脉扩张，我们尝试进行经乳头引流。然而，由于主胰管完全破裂，胰管引流失败。其次，我们进行了内镜超声引导引流。透壁引流后，炎症改善，并成功进行了AAA支架植入术。炎症得到解决，他已经免费从感染超过2年后的procedure.CONCLUSION这种情况下，强调了继续随访的重要性，患者的复发后，WON胰腺横断治疗。
BACKGROUNDThere have been few reports about the late effects of disconnected pancreatic duct syndrome (DPDS). Although few reports have described the recurrence interval of pancreatitis, it might be rare for recurrence to occur more than 5 years later. Herein, we describe a case of recurrence in an 81-year-old man after the treatment of walled-off necrosis (WON) with pancreatic transection 7 years ago.CASE SUMMARYAn 81-year-old man visited our hospital with chief complaints of fever and abdominal pain 7 years after the onset of WON due to severe necrotic pancreatitis. His medical history included an abdominal aortic aneurysm (AAA), hypertension, dyslipidemia, and chronic kidney disease. Computed tomography (CT) scan showed that the pancreatic fluid collection (PFC) had spread to the aorta with inflammation surrounding it, and CT findings suggested that bleeding occurred from the vasodilation due to splenic vein occlusion. First, we attempted to perform transpapillary drainage because of venous dilation around the residual stomach and the PFC. However, pancreatic duct drainage failed because of complete main pancreatic duct disruption. Second, we performed endoscopic ultrasound-guided drainage. After transmural drainage, the inflammation improved and stenting for the AAA was performed successfully. The inflammation was resolved, and he has been free from infection for more than 2 years after the procedure.CONCLUSIONThis case highlights the importance of continued follow-up of patients for recurrence after the treatment of WON with pancreatic transection.