Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
권호 표지

A Case of a Pancreaticogastric Fistula Following Acute Pancreatitis

급성 췌장염 후에 발생한 췌장-위루 1예

  • Youn, Jae-Sung (Department of Internal Medicine, St. Carollo Hospital) ;
  • Park, Hyeuk (Department of Internal Medicine, St. Carollo Hospital) ;
  • Lee, Min-Geun (Department of Internal Medicine, St. Carollo Hospital) ;
  • Kim, Woo-Jong (Department of Internal Medicine, St. Carollo Hospital) ;
  • Mun, Jang-Sik (Department of Internal Medicine, St. Carollo Hospital) ;
  • Myoung, Bo-Hyun (Department of Internal Medicine, St. Carollo Hospital) ;
  • Kim, Do-Hyun (Department of Internal Medicine, St. Carollo Hospital) ;
  • Kim, Ho-Dong (Department of Internal Medicine, St. Carollo Hospital)
  • 윤재성 (순천 성가롤로병원 내과) ;
  • 박혁 (순천 성가롤로병원 내과) ;
  • 이민근 (순천 성가롤로병원 내과) ;
  • 김우종 (순천 성가롤로병원 내과) ;
  • 문장식 (순천 성가롤로병원 내과) ;
  • 명보현 (순천 성가롤로병원 내과) ;
  • 김도현 (순천 성가롤로병원 내과) ;
  • 김호동 (순천 성가롤로병원 내과)
  • Published : 2011.04.30
⟨ Previous Next ⟩

Abstract

A pancreatic fistula (PF) is an abnormal connection between the pancreas and adjacent or distant organs, structures, or spaces resulting from leakage of pancreatic secretions from disrupted pancreatic ducts. A PF is a rare complication that occurs during a acute and chronic pancreatitis or after traumatic or surgical disruption of the pancreatic duct. PFs are frequently classified as internal or external depending upon whether they communicate with an internal organ or the skin. Pancreatico- colonic fistulas are the most common, whereas pancreatico-gastric fistulas are the rarest. We report a rare case of a pancreatico-gastric fistula complicated by acute pancreatitis.

췌장루는 급성 또는 만성 췌장염이나 췌장의 손상 등에 의한 췌관의 파괴로 인접 장기 사이에 교통로가 존재하는 것으로서 임상적으로 외부 췌장루가 흔하고 내부 췌장루는 드물다. 특히 내부 췌장루 중에서도 췌장-대장루가 대부분이고 췌장-위루는 매우 드물게 보고되었다. 46세 여자 환자로 약 20일 전부터 발생한 심와부 동통을 주소로 내원하였다. 복부 CT에서 위저부의 소만 부위까지 확장된 췌장 주위의 염증성 침윤이 관찰되었고 상부위장관내시경에서 위 전정부 후벽에 농을 동반한 누공이 보였다. ERCP에서 췌장 체부로부터 위장과 연결된 누공을 확인할 수 있었다. 환자는 내과적 치료 후 증상 호전 및 누공의 소실을 확인하고 현재 추적관찰 중이다. 본 증례는 급성 췌장염 후 발생한 췌관-위루 합병증으로서 내과적 치료로 호전된 드문 증례로 보고한다.

Keywords

References

  1. Fielding GA, McLatchie GR, Willson C, Imrie CW Carter DC. Acute pancreatitis and pancreatic fistula formation. Br J Surg 1989;76:1126-1128. https://doi.org/10.1002/bjs.1800761106
  2. Lipsett PA, Cameron JL. Internal pancreatic fistula. Am J Surg 1992;163:216-220. https://doi.org/10.1016/0002-9610(92)90104-Y
  3. Sun JM, Kang CG, Ha HD, et al. A case of pancreatico- pleural fistula following chronic recurrent pancreatitis. Korean J Gastroenterol 1994;26:384-388.
  4. Lee S, Jang AS, Yang SW, Seo JP, Joh NJ, Park HB. A case of pancreaticogastric fistula after chronic relapsing pancreatitis. Korean J Gastroenterol 1999;33:864-869.
  5. Kim C, Park JJ, Kim YK, et al. Two case of spontaneous duodenal fistula complicating recurrent acute pancreatitis. Korean J Gastroenterol 2000;35:522-528.
  6. Kawachi SI, Ogawa T, Ukita M, et al. Spontaneous healing of pancreatic abscess after fistulization to the duodenal bulb. Am J Med Sci 1997;314:44-46. https://doi.org/10.1097/00000441-199707000-00010
  7. Kobayashi H, Itoh T, Shima N, et al. Periduodenal panniculitis due to spontaneous rupture of a pancreatic pseudocyst into the duodenum. Abdom Imaging 1995;20:106-108. https://doi.org/10.1007/BF00201513
  8. Tsiotos GG, Smith CD, Sarr MG. Incidence and management of pancreatic and enteric fistulas after surgical management of severe necrotizing pancreatitis. Arch Surg 1995;130:48-52. https://doi.org/10.1001/archsurg.1995.01430010050010
  9. Jordan GL Jr. Pancreatic fistula. Am J Surg 1970;119:200-207. https://doi.org/10.1016/0002-9610(70)90034-6
  10. Choi WB, Jang JY, Ham JS, et al. A case of cystoduodenal and cystocolic fistula complicated in pancreatic pseudocyst. Korean J Gastroenterol 1999;33:730-734.
  11. Kozarek RA, Traverso LW. Pancreatic fistulas: etiology, consequences, and treatment. Gastroenterologist 1996;4:238-244.
  12. McLatchie GR, Meek D, Imrie CW. The use of endoscopic retrograde choledochopancreatography (ERCP) in the diagnosis of internal fistulae complicating severe acute pancreatitis. Br J Radiol 1985;58:395-397. https://doi.org/10.1259/0007-1285-58-689-395
  13. Torres AJ, Landa JI, Moreno-Azcoita M, et al. Somatostatin in the management of gastrointestinal fistula. A multicenter trial. Arch Surg 1992;127:97-99. https://doi.org/10.1001/archsurg.1992.01420010115018