Massive gastrointestinal bleeding after acute pancreatitis: Report of a case

Year 2011, , - , 01.08.2011

İbrahim Sakçak Barış Doğu Yıldız Sabri Özden Akın Bostanoğlu Nevzat Akdoğan Mehmet Fatih Avşar

https://doi.org/10.17940/endoskopi.74862

Abstract

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

Akut pankreatiti takiben abondan gastrointestinal sistem kanaması: Olgu sunumu

Abstract

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.

Keywords

Pankreatit, pankreatik psödokist, gastrointestinal kanama

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