The Korean Journal of Medicine

  • 제86권1호
  • /
  • Pages.59-64
  • /
  • 2014
  • /
  • 1738-9364(pISSN)
  • /
  • 2289-0769(eISSN)
대한내과학회 (The Korean Association of Internal Medicine)
권호 표지
DOI QR코드

DOI QR Code

급성 괴사성 췌장염에 동반된 대장 천공 1예

A Case of Colonic Perforation after Acute Necrotizing Pancreatitis

  • 송영진 (인제대학교 의과대학 부산백병원 내과) ;
  • 최정식 (인제대학교 의과대학 부산백병원 내과) ;
  • 박수영 (인제대학교 의과대학 부산백병원 내과) ;
  • 박영진 (인제대학교 의과대학 부산백병원 내과) ;
  • 안민성 (인제대학교 의과대학 부산백병원 외과) ;
  • 배기범 (인제대학교 의과대학 부산백병원 외과) ;
  • 홍관희 (인제대학교 의과대학 부산백병원 외과)
  • Song, Young Jin (Department of Internal Medicine, Busan Paik Hospital, Inje University Collage of Medicine) ;
  • Choi, Jung Sik (Department of Internal Medicine, Busan Paik Hospital, Inje University Collage of Medicine) ;
  • Park, Su Young (Department of Internal Medicine, Busan Paik Hospital, Inje University Collage of Medicine) ;
  • Park, Young Jin (Department of Internal Medicine, Busan Paik Hospital, Inje University Collage of Medicine) ;
  • An, Min Sung (Department of General Surgery, Busan Paik Hospital, Inje University Collage of Medicine) ;
  • Bae, Ki Beom (Department of General Surgery, Busan Paik Hospital, Inje University Collage of Medicine) ;
  • Hong, Kwan Hee (Department of General Surgery, Busan Paik Hospital, Inje University Collage of Medicine)
  • 투고 : 2012.12.23
  • 심사 : 2013.01.25
  • 발행 : 2014.01.01
⟨ 이전 논문 다음 논문 ⟩

초록

급성 췌장염 환자에게 대장 천공이 생기는 경우는 매우 드물지만 사망률이 50% 이상인 치명적인 합병증이므로 중증 급성 췌장염 환자를 치료할 때는 대장 관련 합병증도 고려하여야 한다. 본 증례에서는 급성 췌장염으로 입원한 50세 남자 환자를 치료하던 중 진단 후 22일째에 대장의 천공을 발견하였다. 췌장 효소가 풍부한 염증 삼출물의 직접적인 작용으로 대장의 괴사와 천공이 발생한 것이다. 장 절제술과 괴사 조직 절제 및 배액 치료를 하여 환자를 살려낼 수 있었다. 우리나라에서 급성 췌장염에 의해서 간 굽이나 우측 대장이 천공되어 즉시 수술한 보고가 없다. 이에 저자들은 급성 췌장염 후에 발생한 대장 천공의 예를 문헌고찰과 함께 보고하고자 한다.

Colonic perforation after acute necrotizing pancreatitis is a very rare but critical complication. The mortality rate is greater than 50%. Therefore, a high index of suspicion is needed for early detection of the complication. We present a case of a 50-year-old man diagnosed as colonic perforation after acute necrotizing pancreatitis. During the treatment course, fecal material was drained via a pleural drainage tube. Colonic perforation was confirmed on CT scan. The pathogenesis of colonic perforation in this case involved direct spread of pancreatic enzymes and inflammatory exudate. He was treated successfully with colectomy, ileostomy, debridement of necrotic tissue, and drainage.

키워드

참고문헌

  1. Van Minnen LP, Besselink MG, Bosscha K, Van Leeuwen MS, Schipper ME, Gooszen HG. Colonic involvement in acute pancreatitis: a retrospective study of 16 patients. Dig Surg 2004;21:33-38. https://doi.org/10.1159/000075824
  2. Mohamed SR, Siriwardena AK. Understanding the colonic complications of pancreatitis. Pancreatology 2008;8:153-158. https://doi.org/10.1159/000123607
  3. Cho HG, Chung JP, Yum JS, et al. Spontaneous bowel perforation during the course of acute pancreatitis: a case report. Yonsei Med J 1996;37:158-164. https://doi.org/10.3349/ymj.1996.37.2.158
  4. Gardner A, Gardner G, Feller E. Severe colonic complications of pancreatic disease. J Clin Gastroenterol 2003;37:258-262. https://doi.org/10.1097/00004836-200309000-00012
  5. Aghenta AA, Kim HJ. An unusual case of colon perforation complicating acute pancreatitis. Case Rep Gastroenterol 2009;3:207-213. https://doi.org/10.1159/000226609
  6. Han YS, Dong SH, Kim HS, et al. A case of bowel infarction accompanied by acute necrotizing pancreatitis. Korean J Gastroenterol 2002;39:446-449.
  7. Won CH, Chan LY, Kyu LJ, et al. A case of gastric and colonic fistulas with pancreatic and peripancreatic abscess after acute necrotizing pancreatitis. Korean J Med 2000;58:675-680.
  8. Kim YK, Dong SH, Kim HJ, et al. A case of pancreaticocolonic fistula after acute pancreatitis. Korean J Gastroenterol 1992;24:1186-1191.
  9. Pyun DK, Kim KJ, Ye BD, et al. Two cases of colonic obstruction after acute pancreatitis. Korean J Gastroenterol 2009;54:180-185. https://doi.org/10.4166/kjg.2009.54.3.180
  10. Sohn BS, Jung JH, Song YT. Colonic complication of acute necrotizing pancreatitis: a case report. J Korean Assoc Pediatr Surg 2003;9:113-116.
  11. Chung NS, Kim YS, Park CH, et al. A case of colon obstruction developed during the recovery period of acute pancreatitis. Korean J Gastroenterol 2005;45:206-209.
  12. Yoo SS, Choi SK, Lee DH, et al. A case of colon obstruction developed as a complication of acute pancreatitis. Korean J Gastroenterol 2008;51:255-258.
  13. Cho YD, Hong SJ, Moon JH, et al. Stenosis of the colon due to chronic pancreatitis mimicking colon cancer. Korean J Gastrointest Endosc 1998;18:605-610.
  14. Aldridge MC, Francis ND, Glazer G, Dudley HA. Colonic complications of severe acute pancreatitis. Br J Surg 1989;76:362-367. https://doi.org/10.1002/bjs.1800760416
  15. Kukora JS. Extensive colonic necrosis complicating acute pancreatitis. Surgery 1985;97:290-293.