급성 췌장염 이후 발생한 후복막강 농양에 속발된 위와 대장 누공의 1예

Abstract

According to several reports, the incidence of pancreatic and peripancreatic abscess after acute pancreatitits is quoted at about 5 percentage and this rare complication may cause fistulas with multiple intra- abdominal organs. Mortality rates are nearly 100 per cent, mostly due to sepsis and hemorrhage in the abscence of surgical intervention and even with surgical drainage and celiotomy, death rate of 30 to 50 percentage are noted due to recurrence. The pathogenesisi of these fistulas may be multifactorial ; activated pancreatic enzyme and the products of secondary infection penetrating visceral wall directly, and vascular thrombosis and shock causing ischemic necrosis of the gastrointestinal wall. The gastrointestinal fistulas after acute necrotizing pancreatitis have been reported rarely in Korea. The authors experienced a sixty three year old male patient case of gastric and colonic fistulas in communication with retroperitoneal pancreatic abscess after acute pancreatitis. The patient received broad- spectrum antibiotics and percutaneous catheter drainage without surgical intervention. After treatment, he recovered well complete. Conservative care with drainage procedure may be a suitable alternative for managing the gastrointestinal fistulas with the pancreatic and peripancreatic abscess after acute nectrotizing pancreatitis .(Korean J Med 58:675- 680, 2000)