A 70-year-old man was admitted to the hospital because of sudden, upper abdominal and back pain. Laboratory and image data indicated acute pancreatitis. Shortly after the admission, pancreatic and liver abscess with bacteremia developed. Antibiotic therapy seemed effective. A month later, spontaneous fistulization of the pancreatic abscess to the duodenal bulb was found by gastroduodenal fiberscopy. Injection of contrast medium into the duodenal orifice showed that the fistula was draining the abscess and that no other fistula formed from the abscess. Endoscopic retrograde cholangiopancreatogram indicated no fistula formation to the pancreatic duct. The pancreatic abscess became smaller and was not visible using computerized tomography and ultrasonography 3 months later and thereafter. Closure of the duodenal orifice was ascertained by the endoscopy. It is suggested that retrograde infection from the fistula was prevented by the single fistulization to the acidic duodenal bulb, which is not supposed to allow most bacterial growth. Pancreatic abscess usually necessitates operative treatment, even with fistulization to the alimentary tract. It seems likely that the single, small fistulization to the bulb, in addition to the lack of underlying disease and medical and nutritional support, facilitated the spontaneous healing process.

译文

一名70岁的老人因突然上腹部和背部疼痛入院。实验室及影像资料提示急性胰腺炎。入院后不久,出现了胰腺和肝脓肿伴菌血症。抗生素治疗似乎有效。一个月后,胃十二指肠纤维镜检查发现胰腺脓肿对十二指肠球的自发性纤维化。将造影剂注射到十二指肠孔中,表明瘘管正在排出脓肿,并且脓肿没有形成其他瘘管。内镜逆行胰胆管造影显示胰管无瘘形成。3个月后及其后,使用计算机断层扫描和超声检查看不到胰腺脓肿。通过内窥镜检查确定十二指肠口的闭合。建议通过对酸性十二指肠球的单次纤维化来防止瘘管的逆行感染,这不应允许大多数细菌生长。胰腺脓肿通常需要手术治疗,即使对消化道进行造瘘。除了缺乏潜在的疾病以及医学和营养支持外,球茎的单一小纤维化似乎很可能促进了自发愈合过程。

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