以急性胰臟炎表現的醫源性十二指腸壁層內血腫

Iatrogenic Duodenal Intramural Hematoma Presenting as Acute Pancreatitis

十二指腸壁層內血腫是一種少見的疾病，而在這些發生的病例之中，醫源性十二指腸壁層內血腫被認為是最罕見的。在此我們報告一個以急性胰臟炎表現的醫源性十二指腸壁層內血腫的病例。這是一位二十八歲的男性，他在因為急性十二指腸潰瘍合併出血並接受治療性內視鏡後出現嚴重的噁心及嘔吐。生化學檢查發現血中血清澱粉脢、脂肪脢及總膽紅素上升，他被初步診斷為急性胰臟炎並接受治療。電腦斷層掃瞄發現一個腫瘤位於十二指腸的第二部分及第三部分並壓迫到管腔。我們替病人再重做一次胃鏡，結果發現有一壁層內血腫由十二指腸的遠端凸出到十二指腸的球部及第一部分的交界處。病人接受了手術將該腫塊完全吸除掉。病人在手術後迅速的康復。當碰到一位在接受診斷或治療性內視鏡後發生嚴重噁心、嘔吐或胃痛時，特別是在伴隨有血清澱粉、脂肪上升或黃疸時，應該考慮十二指腸壁層內血腫發生的可能性。

Duodenal intramural hematomas are very uncommon. They are usually caused by blunt abdominal trauma and can also occur in patients who receive anticoagulant therapy or who present with blood dyscrasias or pancreatic disease. Among such cases, iatrogenic duodenal intramural hematomas are considered extremely rare. The authors report a case of iatrogenic duodenal intramural hematoma presenting as acute pancreatitis. The patient was a 28-year-old male admitted due to severe nausea and vomiting which developed after receiving therapeutic endoscopy for bleeding acute duodenal ulcer. Elevated serum amylase, lipase and total bilirubin were noted and acute pancreatitis was the initial diagnosis. On abdominal computed tomography (CT) a mass lesion was found compressing the duodenal lumen. Panendoscopy was performed and a submucosal hematoma protruding from the distal part to the junction of the bulb and first portion of duodenum was found. The patient underwent surgery and the hematoma was completely evacuated. He gradually recovered after the operation. The possibility of iatrogenic duodenal intramural hematoma should be considered in any patient presenting with severe nausea/vomiting or epigastric pain after diagnostic or therapeutic endoscopy, especially if there is jaundice or elevated serum amylase/lipase.