仮性膵囊胞内に出血した慢性膵炎の1例

A Case of Hemorrhage into Pancreatic Pseudocyst

　近年の膵疾患の診断技術の向上にはめざましいものがある．最近われわれは，慢性膵炎経過中に仮性膵囊胞と左胃大網動脈が交通し，膵囊胞内へ出血したと考えられる症例を経験し，術後の検索から血管撮影が本症の診断上もっとも有用であることを知ったので文献的考察を加えて報告する．

　A 62-year-old-man entered the Yachiyo Hospital on February 14, 1977, complaining of anorexia, upper abdominal fullness and epigastralgia. The patient had been a heavy drinker for 30 years. He had no past history or family history of gastrointestinal disease.

　Barium meal X-ray examination demonstrated an extrinsic pressure on the upper part of the gastric body and the deformity of the fornix. ERCP revealed an irregular main pancreatic duct and a pseudocyst at the body of the pancreas. Selective celiac angiogram showed an extravascular retention of the contrast medium communicated with the right gastroepiploic artery. This retention was located around the tail of the pancreas and did not seem to be the same pseudocyst found by ERCP because of its location. Laparotemy was performed on March 18, 1977. The body and tail of pancreas was resected. There were two cysts, one of which adhered to the stomach. The other was located at the tail of the pancreas and its content was coagulated blood.

　Microscopic examination of the resected specimen revealed fibrosis and many hemorrhagic and necrotic lesions.

　The pertinent literature is reviewed.