Successful management of walled-off necrosis and pseudo-aneurysm related with severe acute pancreatitis;a case report

集学的治療により救命し得た重症急性膵炎の一例

Successful management of walled-off necrosis and pseudo-aneurysm related with severe acute pancreatitis;a case report

Creators Ogawa Ryo

Creators Kaino Seiji

Creators Shinoda Syuhei

Creators Kawano Michitaka

Creators Harima Hirofumi

Creators Suenaga Shigeyuki

Creators Ishikawa Tsuyoshi

Creators Kaino Miyuki

Creators Kurokawa Fumie

Creators Sakaida Isao

症例は64歳女性.2013年7月に心窩部痛を主訴に近医を受診し,急性膵炎の診断で治療が開始された.翌日,重症と判定され当院へ転院となり,大量輸液,蛋白分解酵素阻害薬･抗生剤膵局所動注療法,持続的血液濾過透析(Continuous hemodiafiltration:CHDF)による加療を開始した.炎症は改善傾向にあったが,第34病日に発熱を認め,CTで膵周囲から上腸間膜動脈周囲に感染性被包化壊死(walled-off necrosis:WON)を認めた.抗生剤投与による保存的加療では改善せず,経十二指腸および経皮経肝膿瘍ドレナージを施行した.第84病日にWON内の仮性動脈瘤が破裂し,消化管出血を来したが,経動脈的塞栓術により止血を得た.その後の経過は良好であり,第192病日に退院となった.今回多様な合併症が出現し,集学的治療により救命し得た重症急性膵炎の一例を経験したため,若干の文献的考察を含めて報告する.

A 64-year-old female visited her local hospital in July 2013 with the chief complaint of epigastralgia. She was diagnosed with acute pancreatitis and treatments were started. The next day, worsening of the disease was determined and she was transferred to our hospital. Then intensive treatment was started with continuous regional arterial infusion of protease inhibitors, antibiotics, and continuous hemodiafiltration(CHDF).Although inflammation improved gradually, on day 34, the patient developed fever. CT scan revealed walled-off necrosis(WON)near the superior mesenteric artery. Conservative treatment with antibiotics administration led to no improvement and therefore, transduodenal drainage and percutaneous transhepatic abscess drainage were performed. On day 84, the pseudo-aneurysm in the WON ruptured, and gastrointestinal bleeding occurred. Hemostasis was achieved by transarterial embolization. The patient made steady progress. Then she was discharged from the hospital on day 192. Here we experienced a case of severe acute pancreatitis that developed various complications and was successfully treated using multimodal therapy. We report our case with a brief review of the literature.

[ISSN]0513-1731

[NCID]AN00243156