PMC9493275_01
Abdominal CT imaging of different therapeutic periods. (A) First abdominal CT after bicycle accident: the tail of the pancreas was thickened, lumpy high-density shadows near the tail of the pancreas, and patchy isodensity shadows around (the possibility of hematocele and exudation). (B) Abdominal CT 3 weeks later: PPC formation with a maximum cross size of ~6.5 cm x 6.8 cm. (C) During the operation, the ultrasound endoscope found that the echo-free zone existed in the area, with a slightly high echo in the shape of a mass, a weak echo in the shape of a floating dot, and no blood flow signal in the area. (D) Postoperative abdominal CT: PPC in the tail of the pancreas was significantly reduced, with tubular shadows and little air accumulation in the corresponding area. (E) Abdominal CT 10 days after the previous one (D) multiple strip-shaped extremely high-density shadows in the tail of the pancreas and a few surrounding strips with slightly lower density.
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Abdominal CT (Figure 2A) showed that the tail of the pancreas was thickened, lumpy high-density shadows could be seen near the tail of the pancreas, and patchy isodensity shadows could be seen around it, which suggested the possibility of hematocele and exudation. Finally, abdominal CT was reviewed and suggested PPC formation with a maximum cross size of ~6.5 cm x 6.8 cm, accompanied by a small amount of peripheral exudation and effusion (Figure 2B). The echo-free zone existed in the area, with a slightly high echo in the shape of a mass, a weak echo in the shape of a floating dot, and no blood flow signal in the area (Figure 2C). Postoperative abdominal CT (Figure 2D) showed that cystic lesions in the tail of the pancreas were significantly reduced, with tubular shadows and little air accumulation in the corresponding area, and a small amount of exudate could be seen. Abdominal CT was re-examined 10 days later (Figure 2E).
Endoscopic ultrasonography-guided cyst puncture and drainage of pseudocysts through the gastric wall. (A) The cyst site was punctured and dilated, and the nasal cyst tube was inserted. (B) Placement of the first double pigtail stent. (C) Two double pigtail stents and a nasal cyst tube were placed in a good position.
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A nasal cyst tube with a diameter of 7 F was placed in the cyst along the other guide wire, and the catheter was extracted from the nasal cavity (Figures 3A-C).
Titanium clip closure of abnormal blood vessels in the Dieulafoy's disease under gastroscopy. (A) After cleaning the old bleeding in the gastric cavity, continuous bleeding of exposed malformed blood vessels can be seen. (B) There was no obvious abnormality in the mucosa around the lesion, and the exposed artery was bleeding quickly. (C) Titanium clips were used to clip the exposed abnormal blood vessels to stop bleeding.
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As a result, the intraoperative supplementary diagnosis was gastric Dieulafoy's disease (Figures 4A-C).
Removal of stents under gastroscopy and review of Dieulafoy's disease. (A) Gastric mucosa was smooth. (B) Titanium clips on the greater curvature side of the gastric fundus were well fixed, and no bleeding or other lesions were observed. (C) The double pigtail stents were removed, and no abnormalities were found.
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In total, 3 months later, the patient returned to the hospital for transendoscopic stent removal (Figures 5A-C).