A 24-year-old woman with systemic lupus erythematosus presented to the hospital with acute pancreatitis and melena. Upper endoscopy revealed active hemorrhage via the ampulla of Vater. Visceral arteriography was initially unremarkable. Subsequent provocative arteriography (Fig 1, early and late phases were combined) with visceral injection of 2 mg tissue plasminogen activator, 3,000 U heparin, and 100 mug nitroglycerin revealed extravasation from the pancreatica magna artery (short arrow, Fig 1) into the pancreatic duct (long arrow, Fig 1) and duodenum (arrowheads, Fig 1). A 2 x 3-mm platinum coil was embolized into this branch; completion arteriogram (Fig 2, arrow points to coil) demonstrated hemostasis. Her abdominal pain and hemorrhage resolved, but recurrent melena 1 week later necessitated another arteriogram (not shown); minimal pancreatic duct opacification from a bleeding caudal pancreatic arterial branch was identified and embolized. Four months later, there had been no recurrent bleeding and the patient was gaining strength.
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机译：一名患有系统性红斑狼疮的24岁妇女因急性胰腺炎和黑便病入院。上消化道镜检查显示通过Vater壶腹发生活动性出血。内脏动脉造影起初并不明显。随后的挑衅性动脉造影（图1，早期和晚期相结合），内脏注射2 mg组织纤溶酶原激活剂，3,000 U肝素和100杯硝酸甘油，显示从巨大的胰腺动脉（短箭头，图1）渗入胰管。 （长箭头，图1）和十二指肠（箭头，图1）。将一个2 x 3毫米的铂金线圈栓塞到该分支中。完成动脉造影（图2，箭头指向线圈）显示止血。她的腹痛和出血得以缓解，但1周后复发的黑斑病需要再次进行动脉造影（未显示）。确定并栓塞了从出血的尾胰胰腺动脉分支引起的最小胰管浑浊。四个月后，没有再出血，患者的体力有所增强。
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