A CASE OF ACUTE PANCREATITIS WITH SPONTANEOUS MASSIVE BLEEDING INTO PERITONEAL CAVITY

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  • 腹腔内出血で発症した急性膵炎の１例

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Massive bleeding may complicate the course of acute pancreatitis. Bleeding occurs usually after operation including necrosectomy, and the main pathogenetic mechanism of bleeding is mediated by pseudocysts or abcess. Spontaneous bleeding due to acute pancreatitis is a rare, but frequently fatal complication of acute pancreatitis. Especially, intraperitoneal hemorrhage is a distinctly less common manifestation. Severe inflammation and/or regional necrosis may cause erosion of major vessels or peripancreatic vessels, and their eventual rupture may result in massive bleeding into peritoneal cavity. Symptoms appeared just before lethal bleeding, too late to even hazard a diagnosis. A rapid and accurate diagnosis is critically important. We report a case of massive intraperitoneal bleeding owing to disruption of peripancreatic vessels in a patient recovering from acute pancreatitis. Diagnosis of bleeding was made by computed tomography and ultrasound-guided blood aspiration. The source of the bleeding was identified intraoperatively, and a distal pancreatectomy and a splenectomy were performed. Our case confirms the necessity to add massive intraperitoneal venous bleeding to the list of differential diagnoses for sudden deterioration in patients with acute pancreatitis.

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