인하대병원 최윤아

C. C : melena (onset : 2days ago) Present illness : Case presentation 집답회 Age/sex : M/51 C. C : melena (onset : 2days ago) Present illness : 06.11월 duodenal ca 진단 받고 휘플씨 수술과 06.12월 보존적 1차 항암치료 (5-FU+CDDP)를 투여 받았다. 07.2월에 내원 2일전부터 시작된 간헐적인 흑색변 및 어지러움증으로 내원하였다.

- general weakness (+), poor oral intake (+) - dyspnea(+) Case presentation 집답회 R.O.S - general weakness (+), poor oral intake (+) - dyspnea(+) - dizziness(+),melena (+), hematochezia (-) - abdominal pain (-) Physical examination V/S :144/84mmHg-114회/분-20회/분-36℃ HEENT isocoric pupil size pupil light reflex (+/+) anemic conjunctiva anicteric sclera

Symmetric expansion without retraction CBS and RHB Abdomen Soft & flat Case presentation 집답회 Physical examination Chest Symmetric expansion without retraction CBS and RHB Abdomen Soft & flat Normoactive bowel sound T/RT (-/-), hepatosplenomagaly(-) Back & Extremity Costovertebral tenderness (-/-) Pretibial pitting edema (-/-) Skin rash (-) rectal exam : positive L-Tube irrigation(-)

total protein 5.6g/dL, albumin 3.1 g/dL, T. bil : 0.3 mg/dL, Case presentation 집답회 Lab finding - CBC : 5200/mm3-4.4g/dL-287000/mm3 (Neu 53.0%, Lym 38%) - Admission PANEL total protein 5.6g/dL, albumin 3.1 g/dL, T. bil : 0.3 mg/dL, AST 19 IU/L, ALT 11 IU/L BUN/Cr 20/0.7 mg/dL - PT 76% (INR 1.20) a PTT 31.3 sec

EGD, Colonoscopy, Bleeding scan, Angio mesenteric CT

Case presentation 집답회 경과 07.1.22-07.2.7 까지 입원 하면서 Packed RBC 6 Pint transfusion 시행 하면서 Bleeding 없어 경과 관찰 후 퇴원하였으나 다음날 다시 흑색변 으로 입원 - CBC : 8000/mm3-7.7 g/dL-302000/mm3 (Neu 58.5%, Lym 34.4%) Rectal exam: Positive

Case presentation 집답회 Hyperemic elevated mucosal lesion (1.2Cm) with easy touch bleeding at hepaticojejunostomy stite

경과 #6 FP chemo 까지 치료 한뒤에 07.10 월 다시 melena, hematochezia 로 내원 Case presentation 집답회 경과 #6 FP chemo 까지 치료 한뒤에 07.10 월 다시 melena, hematochezia 로 내원

Case presentation 집답회 EGD & Colonoscopy 시행

Colonoscopy

Case presentation 집답회 재출혈 한달뒤 07.11월 choledochojejunostomy revision 시행 하였고 08. 4월 출혈 없는 상태로 경과 관찰하고 있음

Morbidity rate remains high and is currently between 30% and 40% Review Mortality rate after pancreatoduodenectomy (PD) has decreased during the last decade to 0-5% Morbidity rate remains high and is currently between 30% and 40% The most common complications after PD are pancreatic leak and pancreatic fistula, gastric stasis, bile leak, intra-abdominal abscess and haemorrhage Management of Complications after Pancreaticoduodenectomy in a High Volume Centre: Results on 150 Consecutive Patients. Claudio Bassi, Massimo Falconi, Roberto Salvia, Giuseppe Mascetta, Enrico Molinari, Paolo Pederzoli Dig Surg 2001;18:453-458

Review Haemorrhage following Pancreaticoduodenectomy: Risk Factors and the Importance of Sentinel Bleed I.Koukoutsis, R. Bellagamda, G.Morris-Stiff, S. Wickremesekera, C.Coldham, S.J.Wigmore, A.D.Mayer, D.F. Nirza Dig Surg 2006;23:224-228

Haemorrhage following Pancreaticoduodenectomy: Risk Factors and the Importance of Sentinel Bleed I.Koukoutsis, R. Bellagamda, G.Morris-Stiff, S. Wickremesekera, C.Coldham, S.J.Wigmore, A.D.Mayer, D.F. Nirza Dig Surg 2006;23:224-228

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