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嗜酸性粒细胞性肠炎伴复发性急性胰腺炎一例

邹龙 王强 吴晰 王志伟 杨爱明

邹龙, 王强, 吴晰, 王志伟, 杨爱明. 嗜酸性粒细胞性肠炎伴复发性急性胰腺炎一例[J]. 协和医学杂志, 2022, 13(6): 1100-1104. doi: 10.12290/xhyxzz.2021-0803
引用本文: 邹龙, 王强, 吴晰, 王志伟, 杨爱明. 嗜酸性粒细胞性肠炎伴复发性急性胰腺炎一例[J]. 协和医学杂志, 2022, 13(6): 1100-1104. doi: 10.12290/xhyxzz.2021-0803
ZOU Long, WANG Qiang, WU Xi, WANG Zhiwei, YANG Aiming. Eosinophilic Enteritis Accompanied with Recurrent Acute Pancreatitis: A Case Resport[J]. Medical Journal of Peking Union Medical College Hospital, 2022, 13(6): 1100-1104. doi: 10.12290/xhyxzz.2021-0803
Citation: ZOU Long, WANG Qiang, WU Xi, WANG Zhiwei, YANG Aiming. Eosinophilic Enteritis Accompanied with Recurrent Acute Pancreatitis: A Case Resport[J]. Medical Journal of Peking Union Medical College Hospital, 2022, 13(6): 1100-1104. doi: 10.12290/xhyxzz.2021-0803

嗜酸性粒细胞性肠炎伴复发性急性胰腺炎一例

doi: 10.12290/xhyxzz.2021-0803
基金项目: 

北京市重点建设一流专业项目 2021zlgc1106

详细信息
    通讯作者:

    王强, E-mail:pekingunion@aliyun.com

  • 中图分类号: R576; R593.1; R593.2

Eosinophilic Enteritis Accompanied with Recurrent Acute Pancreatitis: A Case Resport

Funds: 

Beijing's Key Construction of First-class Professional Projects 2021zlgc1106

More Information
  • 摘要: 本文报道1例具有阿司匹林加重性呼吸系统疾病病史的患者,出现嗜酸性粒细胞性肠炎和复发性急性胰腺炎。此病例具有多系统受累临床特征及嗜酸性粒细胞浸润组织学表现,故临床疑诊为嗜酸性肉芽肿性多血管炎。患者合并出现急性胰腺炎是该疾病非常少见的临床表现;此外,患者存在胰腺假性囊肿,囊肿穿刺引流术后出现迟发性假性动脉瘤出血,经血管造影栓塞治疗后成功止血,术后1年复查病情稳定。该病例的诊断和处理过程复杂,其诊治经验值得临床医师借鉴。
    作者贡献:邹龙、王强负责收集临床资料,撰写和修改论文;吴晰、王志伟负责协助完成手术,采集并分析相关数据;杨爱明负责临床资料及数据审核。
    利益冲突:所有作者均声明不存在利益冲突
  • 图  1  患者胰腺影像学特征

    A.2018年2月,患者急性胰腺炎发作时的腹部增强CT图像,可见胰腺肿大,部分坏死,伴胰周积液(箭头);B.2019年3月,患者胰腺囊性病变形成后核磁共振胰胆管造影图像,可见囊性病变似与主胰管相通,囊内似有分隔,主胰管(箭头)迂曲扩张

    图  2  患者入院后腹部CT及超声内镜影像学特征

    A.CT可见胰腺形态饱满,胰腺实质密度减低,胰体可见椭圆形低密度影(*),其左侧新见一新月形囊肿(#),边缘清晰,密度尚均匀;B.超声内镜可见胃底旁囊性病变(*)回声均匀,其旁另见低回声病变(#),囊壁显示不清,内见分隔样改变

    图  3  患者上消化道动脉造影图像

    A.引流术后1周上消化道动脉造影,可见肠系膜上动脉分支多发假性动脉瘤形成(箭头);B.引流术后17 d上消化道动脉造影,可见胃网膜右动脉一分支假性动脉瘤及对比剂外溢(箭头)

    图  4  患者术后1年腹部CT示胰体尾部萎缩伴胰管扩张,胰周未见渗出、积液或囊性病变(箭头)

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    [2] Mathew G, Ahmad H. Pancreatic Pseudoaneurysm[M]. Treasure Island: StatPearls, 2020.
    [3] Baek MS, Mok YM, Han WC, et al. A patient with eosino- philic gastroenteritis presenting with acute pancreatitis and ascites[J]. Gut Liver, 2014, 8: 224-227. doi:  10.5009/gnl.2014.8.2.224
    [4] Pinte L, Bǎicuş C. Eosinophilic pancreatitis versus pancreatitis associated with eosinophilic gastroenteritis - a systematic review regarding clinical features and diagnosis[J]. Rom J Intern Med, 2019, 57: 284-295.
    [5] Samter M, Beers RF Jr. Intolerance to aspirin. Clinical studies and consideration of its pathogenesis[J]. Ann Intern Med, 1968, 68: 975-983. doi:  10.7326/0003-4819-68-5-975
    [6] Pesek RD, Reed CC, Muir AB, et al. Increasing Rates of Diagnosis, Substantial Co-Occurrence, and Variable Treatment Patterns of Eosinophilic Gastritis, Gastroenteritis, and Colitis Based on 10-Year Data Across a Multicenter Consortium[J]. Am J Gastroenterol, 2019, 114: 984-994. doi:  10.14309/ajg.0000000000000228
    [7] Itawaki A, Okada M, Kawashima K, et al. Eosinophilic Granulomatosis with Polyangiitis Initially Diagnosed as Eosinophilic Gastroenteritis[J]. Intern Med, 2020, 59: 1029-1033. doi:  10.2169/internalmedicine.3391-19
    [8] Trivioli G, Terrier B, Vaglio A. Eosinophilic granulo-matosis with polyangiitis: understanding the disease and its management[J]. Rheumatology (Oxford), 2020, 59: iii84-iii94. doi:  10.1093/rheumatology/kez570
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    [10] Ball LL, Velasquez SA, Al Jammal OM, et al. Atypical eosinophilic granulomatosis with polyangiitis with spontane-ous aspirin reactivity and immunoglobulin E-mediated anaphylaxis[J]. Ann Allergy Asthma Immunol, 2021, 127: 506-507. doi:  10.1016/j.anai.2021.07.011
    [11] Ameratunga R, Steele R. Eosinophilic granulomatosis with polyangiitis (Churg-Strauss vasculitis) presenting as Samter's triad[J]. J Allergy Clin Immunol Pract, 2018, 6: 280-282. doi:  10.1016/j.jaip.2017.07.006
    [12] Yagi H, Takahashi S, Kibe T, et al. An Autopsy Case of a 5-Year-Old Child with Acute Pancreatitis Caused by Eosinophilic Granulomatosis with Polyangiitis-like Necrotizing Vasculitis[J]. Case Rep Rheumatol, 2019, 2019: 9053747.
    [13] Marvisi M, Uccelli M. A huge pancreatic cyst in eosino-philic granulomatosis with polyangitis[J]. Rheumatology (Oxford), 2021, 60: 4443. doi:  10.1093/rheumatology/keab008
    [14] Berti A, Boukhlal S, Groh M, et al. Eosinophilic granulomatosis with polyangiitis: the multifaceted spectrum of clinical manifestations at different stages of the disease[J]. Expert Rev Clin Immunol, 2020, 16: 51-61. doi:  10.1080/1744666X.2019.1697678
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出版历程
  • 收稿日期:  2021-12-27
  • 录用日期:  2022-01-24
  • 网络出版日期:  2022-03-05
  • 刊出日期:  2022-11-30

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