급성췌장염 후 발생한 후복막강 농양 환자에서 십이지장 누공을 통한 내시경배액술
Endoscopic Drainage Through a Duodenal Fistula in a Patient with a Retroperitoneal Abscess that Developed after Acute Pancreatitis
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초록
급성 췌장염 후 후복막강 농양이 발생하고 이 농양이 소화관과 누공을 형성하는 경우는 빈도가 드물지만 신속한 치료가 이루어지지 않을 경우 사망률이 매우 높은 심각한 합병증이다. 급성 췌장염 후 발생한 췌장 또는 췌장주위 농양은 그 동안 수술이 일차적인 치료방법이었으나, 최근 경피도관배액술이나 내시경초음파를 이용한 경벽배액술 등의 비수술적 치료가 좋은 성적을 보이고 있다. 십이지장 누공이 동반된 후복막강 농양에서 내시경치료에 대한 국내 보고는 아직 없다. 저자들은 43세 남자가 음주 후 발생한 급성 췌장염으로 타 병원에서 치료 도중 후복막강 농양이 발생하여 본원으로 전원 된 후 시행한 십이지장경검사에서 후복막강 농양과 십이지장 제3부사이의 누공을 관찰하고, 내시경으로 누공을 통해 이중 돼지꼬리형 플라스틱 스텐트를 유치시켜 치험한 1예를 경험하여 보고한다.
Abstract
The incidence of retroperitoneal abscess with fistula formation after acute pancreatitis is rare, but the mortality rate for patients with this condition is very high. The standard treatment for this condition has been surgical removal and drainage. However, recent studies have shown that percutaneous catheter drainage or noninvasive endoscopic abscess drainage with using endoscopic ultrasonography is effective and safe for the treatment of pancreatic and peripancreatic abscess. A retroperitoneal abscess with duodenal fistula that developed after acute pancreas and its endoscopic treatment has never been reported on in Korea. We experienced a 45-year-old man who had been treated for acute pancreatitis at other hospital, and he was then referred to our hospital and diagnosed as having a retroperitoneal abscess with fistula, which communicated with the third portion of duodenum, as assessed by abdominal CT and duodenoscopy. So we treated him with endoscopic double-pigtailed stent insertion through the fistulous tract and we drained the abscess. Endoscopic drainage may be a suitable alternative for the management of the retroperitoneal abscess with fistula that develops after acute pancreatitis.
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