Akute nekrotisierende Pankreatitis mit hämorrhagischem Schock bei sekundärer Milzruptur: Ein Fallbericht und Literaturübersicht

 

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Zusammenfassung

Die atraumatische Milzruptur ist eine seltene Komplikation der akuten und chronischen Pankreatitis. Sie entsteht aufgrund ihrer anatomischen Nähe zum Pankreas, beispielsweise als Folge der Erosion großer Pseudozysten oder Walled-of-Nekrosen (WON).

Im Folgenden beschreiben wir den Fall einer 62-jährigen Patientin, welche sich zur weiteren Diagnostik und Therapie einer akuten Pankreatitis mit Ausbildung einer großen Walled-of-Nekrose (WON) im Pankreaskorpus und -schwanz vorstellte. Im Verlauf entwickelte die Patientin einen hämorrhagischen Schock. Eine Notfall-Computertomografie (CT) des Abdomens zeigte eine Milzruptur mit großem Kapselhämatom ohne den Nachweis einer aktiven Blutung. Im Gegensatz zu bereits publizierten Fällen wurde die Patientin ausschließlich minimalinvasiv therapiert: mittels radiologisch gesteuerter langstreckiger Embolisation der Arteria lienalis und mittels endosonografisch angelegtem Lumen-apposing Metall Stent (LAMS). Das Kapselhämatom zeigte sich unter einer Watch-and-wait-Strategie ohne sekundäre Drainage regredient.

Abstract

Atraumatic splenic rupture is a rare complication of acute and chronic pancreatitis. It arises due to its anatomical proximity to the pancreas, for instance, due to erosion of large pseudocysts or walled-of-necrosis (WON).

Following we describe the case of a 62-year-old woman who presented for further diagnostics and treatment of acute pancreatitis with the development of large walled-of necrosis (WON) in the pancreatic corpus and tail. During the course, the patient developed a hemorrhagic shock. An emergency computer tomography (CT) of the abdomen revealed a ruptured spleen with a large capsular hematoma with no evidence of active bleeding. In contrast to previous published case reports, our treatment was exclusively minimal-invasive: by radiological guided embolization of the splenic artery and by endosonographic guided implantation of a lumen apposing metal stent (LAMS). The splenic hematoma was spontaneously regressive without secondary drainage.

Publication History

Received: 08 November 2022

Article published online:
03 February 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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