过敏性肉芽肿性脉管炎患者因肝动脉瘤破裂进入肝内胆管而致黑黑症1例。

S Nakamura, Y Yokoi, S Suzuki, S Sakaguchi, H Muro, M Maeda, H Kawasaki
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引用次数: 11

摘要

1987年6月,一名46岁女性因哮喘发作、发热、白细胞增多伴嗜酸性粒细胞增多而入院。在胃肠检查时发现她患有不明来源的黑肠病。计算机断层扫描发现肝脏有四个低密度区,其中一个肝内病灶形成了一个与肝内管相通的大肝外脓肿。切除肝四节,包括大脓肿,并行胆囊切除术。在切除的肝脏标本中组织病理学观察到愈合的坏死性动脉炎,CT扫描上的四个低密度区域均为坏死灶。其中一人形成肝内胆管瘘,肝动脉瘤破裂进入胆管被发现是黑黑的原因。虽然没有观察到嗜酸性粒细胞浸润和血管外肉芽肿,但根据特征性的临床过程、全身血管炎和外周血嗜酸性粒细胞增多,诊断为过敏性肉芽肿性血管炎。据我们所知,这是第一次报道肝内管穿孔很可能是由肝动脉瘤破裂引起的过敏性肉芽肿性脉管炎患者。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
A case of melena caused by a hepatic aneurysm ruptured into the intrahepatic bile duct in a patient with allergic granulomatous angiitis.

A 46 year old woman was admitted to our institute in June, 1987 with an attack of asthma, as well as remittent fever and leukocytosis accompanied by hypereosinophilia. She was found to have melena from an unknown source upon gastrointestinal examination. Four low-density areas were found in the liver on computed tomography and one of the intrahepatic foci formed a large extrahepatic abscess communicating with the intrahepatic duct on tubography. Resection of the four hepatic segments, including the large abscess, and cholecystectomy were performed. Healed necrotizing arteritis was histopathologically observed in the resected liver specimen, with the four low-density areas on CT scan having all been necrotic foci. One of them formed an intrahepatic biliary fistula and rupture of a hepatic aneurysm into a biliary duct was found to be the cause of melena. Although eosinophil infiltration and extravascular granuloma were not observed, a diagnosis of allergic granulomatous angiitis was made from the characteristic clinical course, systemic vasculitis and peripheral blood eosinophilia. To the best of our knowledge, this is the first report of intrahepatic duct perforation most probably being caused by hepatic aneurysm rupture in a patient with allergic granulomatous angiitis.

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