一例罕见原因的消化道出血！
撰文| 陈徐佳
急诊科来了一个患者，脸色苍白，此前曾大量饮酒，怎么回事？
病例摘要
■现病史
患者，男性，46岁，有酒精滥用史，先前曾患急性胰腺炎，并发急性肺栓塞予抗凝治疗。3周前大量饮酒后表现为深度疲乏，急诊入院。
■体格检查
皮肤黏膜苍白，腹部柔软，触诊无触痛。
■实验室检查
血红蛋白为29g/L，红细胞压积（HCV）为11.9%，平均红细胞体积（MCV）为71.7fL，血小板计数为557k/μL。血生化指标显示低钠血症，钠含量为126mmol/L，尿素氮为3.56mmol/L，肌酐为60μmol/L。除此之外，患者的实验室检查均在正常范围内。患者一年前基线血红蛋白为172g/L。无呕血、黑便或便血的证据。
■影像学检查
食管胃十二指肠镜检查（EGD）显示反流性食管炎（洛杉矶分型D级），Vater乳头区域有血迹（图A），但无明显出血。CT血管造影见图B，EGD显示乳头区域有血迹，进一步行内镜逆行胰胆管造影（ERCP）和内镜下胰胆管造影（EUS）检查，没有进一步的证据提示胰腺出血。
患者进一步接受了CT血管造影，除了胃十二指肠动脉假性动脉瘤（gastroduodenal artery pseudoaneurysm，GDA）外，还显示了一个非特征性的胰腺肿块，胰腺肿块的特征是良性囊性改变，结合ERCP、EUS可能与他先前的急性胰腺炎发作有关。
图A
图B
Q
结合以上信息，你认为最有可能的诊断是？后续如何处理呢？
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