慢性膵炎に合併した脾静脈閉塞によって胃静脈瘤破裂と脾機能亢進症を呈した1例

Abstract

A sixty-five-year-old man was admitted to the hospital because of abdominal pain and hematemesis. He had consumed about 500 ml of sake daily for 45 years. He had experienced occasional abdominal pain and diarrhea since 1998. Computed tomography (CT) of the abdomen at that time demonstrated calcification of the pancreas and he was diagnosed with chronic pancreatitis. He was emergently admitted to the hospital in February, 1999, after he experienced severe abdominal pain and a small amount of hematemesis. Physical examination revealed palpable spleen 5 cm below left costal margin. Laboratory findings showed severe normocytic anemia (Hb 5.9 g/dl), moderate thrombocytopenia (platelet 72,000/ml) and elevated pancreatic enzyme (amylase 142 IU/l and trypsin 1,390 IU/l). ICG R15 was 4.4%. Upper gastrointestinal endoscopy showed ruptured gastric varices, and magnetic resonance angiography (MRA) of the abdomen revealed obstruction of the splenic vein. Splenic vein obstruction, which was the cause of splenomegaly, was thought to be brought about by the chronic pancreatitis. If splenomegaly is present in the patients with pancreatitis without liver cirrhosis, obstruction of the splenic vein should be considered.