胆囊十二指肠瘘继发胆囊假性动脉瘤致失血性休克:病例报告

Hemorrhagic shock secondary to cholecystoduodenal fistula with gallbladder pseudoaneurysm: A case report

背景胆囊十二指肠瘘(cholecystoduodenal fistula, CDF)继发胆囊假性动脉瘤致失血性休克病例罕见,而往往临床结果严重,致死率高.病例概述一例中年男性患者发生不可控制的上消化道大出血,后续通过相关诊疗手段诊断为CDF继发胆囊假性动脉瘤破裂导致失血性休克,经积极治疗后抢救成功.结论CDF多继发于胆囊结石,早期诊断困难,联合应用B超、计算机体层摄影、磁共振胰胆管造影及胃镜、经内镜逆行胰胆管造影可提高早期诊断率,合并胆囊假性动脉瘤致出血时可行数字减影血管造影定位并栓塞止血.手术治疗原则是切除胆囊、取净结石、切断瘘管并修补瘘口.

BACKGROUND Hemorrhagic shock secondary to cholecystoduodenal fistula (CDF) with gallbladder pseudoaneurysm is very rare. CASE SUMMARY A middle-aged man presented with uncontrolled hemorrhage of the upper gastrointestinal tract. A subsequent diagnosis of rupture of gallbladder pseudoaneurysm secondary to cholecystoduodenal fistula was made. After active treatment, the patient was rescued successfully. CONCLUSION Most of CDF cases are caused by cholelithiasis and difficult to diagnose early. The joint application of B-mode ultrasonography, computed tomography, magnetic resonance cholangiopancreatography, gastroscopy, and endoscopic retrograde cholangiopancreatography could improve early diagnosis rate, and digital subtraction angiography can be used in the treatment of CDF with active bleeding. The therapeutic principle of CDF is cholecystectomy, removing calculus, and cutting off and repairing fistula.