抄録
A 32-year-old woman with anorexia nervosa and alcoholic dependency was admitted to our hospital with epigastric pain. Computerized tomography (CT) showed peri-pancreatic fluid collection and a pseudocyst on the pancreatic body. Ten days after admission, her abdominal pain abruptly intensified. Abdominocentesis revealed hemorrhagic ascites, and CT showed extravasation from the dorsal pancreatic artery. Emergency angiography was performed to embolize the point of hemorrhage. Due to a high level of amylase in the ascitic fluid, the patient was diagnosed with a pancreatic fistula from the pancreatic pseudocyst. Insertion of an endoscopic nasopancreatic duct drain (ENPD) was initially unsuccessful due to extravasations from the main pancreatic duct. Percutaneous drainage of the pancreatic pseudocyst was therefore performed. Thirty-two days after admission, ENPD was accomplished. An ERBD (endoscopic retrograde biliary drainage) stent was additionally inserted 43 days after admission. After percutaneous drainage of fluid decreased, the ENPD tube and percutaneous drain were removed. No recurrence of pancreatitis has been observed since discharge one year ago. Findings in this patient suggest that multidisciplinary therapy without surgery is effective for treatment of abdominal bleeding and pancreatic fistula after rupture of a pancreatic pseudocyst.
