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Eosinophilic Enteritis Accompanied with Recurrent Acute Pancreatitis: A Case Resport
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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。
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关键词:
- 嗜酸性粒细胞性肠炎 /
- 急性胰腺炎 /
- 阿司匹林加重性呼吸系统疾病 /
- 嗜酸性肉芽肿性多血管炎 /
- 假性动脉瘤出血
Abstract: This was a patient with a medical history of aspirin-aggravated respiratory disease present with eosinophilic enteritis and recurrent acute pancreatitis. Eosinophilic granulomatosis with polyangiitis was clinically suspected due to the clinical presentation of multiple systems and the histological appearance of eosinophilic infiltrate, but acute pancreatitis was rarely reported in this disease. In addition, the patient developed pancreatic pseudocyst, and delayed pseudoaneurysm hemorrhage occurred after drainage of the pseudocyst. The hemorrhage was successfully treated after angiographic embolization, and the patient remained stable after one year. The case was reported here because both the diagnosis and the management were challenging and worth learning.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)
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