İbrahim SAKÇAK, Barış Doğu YILDIZ, Sabri ÖZDEN, Akın BOSTANOĞLU, Nevzat AKDOĞAN, Mehmet Fatih AVŞAR

Akut pankreatiti takiben abondan gastrointestinal sistem kanaması: Olgu sunumu

61 yaşında kadın olgu alt gastrointestinal sistem kanaması nedeniyle acil servise başvurdu. Şikayetleri iki ay önce sırtta ağrı şeklinde başlamıştı. Sol üst kadranda ele gelen kitle tespit edildi. Anjiografide splenik arter distalinde anevrizma olguğu görüldü ve embolizasyon uygulandı. Laparotomi yapıldığında transvers kolona 2 cm çapında ağızlaşmış kistik lezyonla karşılaşıldı. Kolon segmenti rezeke edilerek uç-uca anastomoz yapıldı. Postoperatif 17. gün dren bölgesinden pankreatik sıvı gelmeye başladı. Drenaj miktarının azalmaması üzerine, endoskopik retrograd kolanjiopankreatografi yapılarak nazo-pankreatik kateter yerleştirildi. Postoperatif 47. gün fistül bölgesinden akıntı kesildi. Patolojide nekroz içeren non- neoplastik kist, kolon ve kist arasında fibrozis bulguları vardı. Akut pankreatit sonrası gastrointestinal sistem kanaması olan olgularda, pankreas, vasküler yapılar ve komşu organlar arasında fistül akılda bulundurulmalıdır.

Anahtar Kelimeler:

Pankreatit, pankreatik psödokist, gastrointestinal kanama

Massive gastrointestinal bleeding after acute pancreatitis: Report of a case

A 61-year-old female patient presented to emergency with gradually increasing lower gastrointestinal bleeding. Her symptoms had started two months before hospitalization with back pain. She had a palpable mass on the left upper abdomen. In digital subtraction angiography, a fusiform aneurysmatic dilatation was seen on the distal splenic artery coiling, and glue injection was performed. On laparotomy, it was seen that the cystic mass was connected to the colonic mucosa with an opening 2 cm in width. Resection of the colon segment and necrotic cyst wall, end-to-end colonic anastomosis and debridement were undertaken. Postoperative follow-up was uneventful until the 17th day, when pancreatic drainage from the previous drain site was observed. As the amount of drainage from the fistula did not decrease, a second endoscopic retrograde cholangiopancreatography with naso-pancreatic stent placement was performed. The fistula closed 47 days after the surgery. Examination of the pathology specimen revealed non-neoplastic cystic wall with necrosis, fibrosis and fistula tract between the colon and the cyst. It should be kept in mind that acute pancreatitis affects neighboring organs and vascular structures, causing low gastrointestinal system bleeding.

Keywords:

Pancreatitis, pancreatic pseudocyst, gastrointestinal hemorrhage,

PDF

___

Udd M, Leppäniemi AK, Bidel S, et al. Treatment of bleeding pseudoane- urysms in patients with chronic pancreatitis. World J Surg 2007; 31: 504-10.
Balachandra S, Siriwardena AK. Systematic appraisal of the management of the major vascular complications of pancreatitis. Am J Surg 2005; 190: 489-95.
Aldridge MC, Francis ND, Glazer G, et al. Colonic complication of seve- re acute pancreatitis. Br J Surg 1989; 76: 362-7.
Kriwanek S, Armbruster C, Beckerhinn P, et al. Improved result after ag- gressive treatment of colonic involvement in necrotizing pancreatitis. Hepatogastroenterologica 1996; 43: 1627-32.
Nicolás de Prado I, Corral de la Calle MA, Nicolás de Prado JM, et al. [Vascular complications of pancreatitis]. Rev Clin Esp 2005; 205: 326- 32.
Suzuki A, Suzuki S, Sakaguchi T, et al. Colonic fistula associated with se- vere acute pancreatitis: report of two cases. Surg Today 2008; 38: 178- 83.
Tüney D, Altun E, Barlas A, et al. Pancreato-colonic fistula after acute necrotizing pancreatitis. Diagnosis with spiral CT using rectal water so- luble contrast media. J Pancreas 2008; 9: 26-9.
Shim KS, Suh JM, Yang YS, et al. Three-dimensional demonstration and endoscopic treatment of pancreaticoperitoneal fistula. Am J Gastroente- rol 1993; 88: 1775-9.
Bergert H, Hinterseher I, Kersting S, et al. Management and outcome of hemorrhage due to arterial pseudoaneurysms in pancreatitis. Surgery 2005; 137: 323-8.
Hyare H, Desigan S, Brookes JA, et al. Endovascular management of ma- jor arterial hemorrhage as a complication of inflammatory pancreatic di- sease. J Vasc Interv Radiol 2007; 18: 591-6.
Sethi H, Peddu P, Prachalias A, et al. Selective embolization for bleeding visceral artery pseudoaneurysms in patients with pancreatitis. Hepatobi- liary Pancreat Dis Int 2010; 9: 634-8.
Nicholson AA, Patel J, McPherson S, et al. Endovascular treatment of vis- ceral aneurysms associated with pancreatitis and a suggested classificati- on with therapeutic implications. J Vasc Interv Radiol 2006; 17: 1279- 85.
Piffaretti G, Tozzi M, Lomazzi C, et al. Splenic artery aneurysms: pos- tembolization syndrome and surgical complications. Am J Surg 2007; 193: 70.
Molnar T, Kurucsai G, Tiszlavicz L, et al. How can a pancreatic neoplasm be diagnosed by colonoscopy? A case report. J Gastrointestin Liver Dis 2007; 16: 189-91.
Garcea G, Krebs M, Lloyd T, et al. Haemorrhage from pancreatic pseu- docysts presenting as upper gastrointestinal haemorrhage. Asian J Surg 2004; 27: 137-40.