내시경적 지혈 후 발생된 폐쇄성 황달과 췌장염을 동반한 십이지장 벽내 혈종 1예
A Case of Intramural Duodenal Hematoma Complicated with Obstructive Jaundice and Pancreatitis following Endoscopic Hemostasis
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초록
십이지장 벽내 혈종은 성인에게는 드물지만 특히 출혈성 경향이 있거나 항응고제를 복용하는 환자에서 십이지장 궤양 출혈의 내시경적 지혈술 후에 발생하기도 한다. 이는 상부위장관내시경 검사, 복부전산화단층촬영 및 저장성십이지장조영술 등에 의해 진단이 가능하다. 내원 1년 전부터 뇌경색으로 항응고제를 복용 중인 64세 남자가 십이지장 궤양 출혈로 내원하여 희석 에피네피린의 주입과 헤모클립을 이용한 내시경적 지혈을 시행 받았으며, 경과 관찰 중 복통과 황달을 호소하였다. 복부전산화단층촬영에서 급성 췌장염소견과 함께 십이지장 제2부에서 제4부 걸쳐 거대한 혈종 소견이 관찰되었고, 추적 내시경 검사에서 점막하 혈종이 십이지장 내강의 대부분을 막고 있었다. 18일간의 보존적 치료 후 십이지장 혈종의 소실과 함께 췌장염 및 황달 증상이 호전되었다. 저자들은 뇌경색을 앓고 있는 환자에서 십이지장 궤양의 내식경적 지혈 후 합병증으로 폐쇄성 황달과 췌장염이 동반된 십이지장 벽내 혈종 1예를 경험하였기에 문헌 고찰과 함께 보고한다.
Abstract
An intramural duodenal hematoma is rarely observed in adults and may occur as an iatrogenic complication after endoscopic treatment for duodenal ulcer bleeding, particularly in patients with bleeding disorders or undergoing anticoagulant therapy. Upper gastrointestinal endoscopy, abdominal CT scan and hypotonic duodenography are used to establish a diagnosis. We report a case of an intramural duodenal hematoma complicated with obstructive jaundice and pancreatitis after endoscopic hemostasis in a patient with a cerebral infarction. A 64-year-old male had duodenal ulcer bleeding, which was treated by a local injection of epinephrine followed by hemoclipping. One to three days after the endoscopic treatment, he complained of abdominal pain and jaundice. The abdominal CT scan revealed acute, edematous pancreatitis and a huge hematoma in the 2nd to 4th portion of the duodenum. The follow-up endoscopy revealed severe stenosis of the duodenal lumen caused by an intramural hematoma. He was treated with conservative management for 18 days. There was gradual improvement in the hematoma that had been complicated by jaundice and pancreatitis. (Korean J Gastrointest Endosc 2007;34:346-350)
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