慢性アルコール性膵炎の再燃増悪時に合併した膵仮性囊胞が巨大粘膜下血腫を形成した1例

Pancreatic Pseudocyst Resulting in a Gastric Submucosal Hematoma, Report of a Case

要旨　患者は53歳の男性で大酒家．上腹部痛を主訴として来院した．10年以上，1日日本酒5合とビール2本を飲酒していた．腹部超音波検査で膵囊胞を認め，腹部CTでも膵周囲に多発する囊胞がみられた．保存的に治療していたが，新たに囊胞が出現し，同時に腹部単純写真上で，左横隔膜下にfree air様のガス像があり，消化管出血も認めたため開腹した．その結果，囊胞が胃壁内に穿通して巨大な胃粘膜下血腫を形成しており，囊胞を含めた膵体尾部切除と胃部分切除および脾摘を行った．膵囊胞が胃壁内に穿通し，巨大血腫を形成することは今までに報告がなく，左横隔膜下の特異なガス像がそのことを示唆した症例であった．

　A 53-year-old man was admitted to our hospital because of upper abdominal pain. He had a history of heavy drinking over the past ten years. On admission, abdominal ultrasonography showed pancreatic cysts and abdominal CT also showed multiple cystic lesions around the pancreas.

　He was thus diagnosed as having chronic pancreatitis associated with pancreatic pseudocyst and treated in a conservative way. Four weeks later, however, a large cyst newly appeared on abdominal CT. At the same time, a finding suggestive of free air on abdominal plain x-ray film. Furthermore, NG-tube insertion yielded blood from the stomach. And then emergency operation was carried out proving that pancreatic pseudocyst had penetrated into the gastric wall resulting in a formation of a large Submucosal hematoma.

　Complications of pancreatic pseudocyst as seen in this case has not yet been reported. Unusual gas pattern under the left hemidiaphragma suggested in retrospect the presence of the gastric submucosal hematoma.