Endoscopy 2013; 45(S 02): E135
DOI: 10.1055/s-0032-1326450
Cases and Techniques Library (CTL)
© Georg Thieme Verlag KG Stuttgart · New York

Acute suppurative pancreatic ductitis associated with pancreatic duct obstruction

T. Fujinaga
Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Osaka, Japan
,
T. Nishida
Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Osaka, Japan
,
M. Miyazaki
Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Osaka, Japan
,
M. Shigekawa
Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Osaka, Japan
,
K. Ikezawa
Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Osaka, Japan
,
K. Iwahashi
Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Osaka, Japan
,
T. Inoue
Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Osaka, Japan
,
T. Yamada
Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Osaka, Japan
,
H. Ezaki
Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Osaka, Japan
,
S. Shinzaki
Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Osaka, Japan
,
T. Yakushijin
Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Osaka, Japan
,
H. Iijima
Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Osaka, Japan
,
M. Tsujii
Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Osaka, Japan
,
T. Takehara
Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Osaka, Japan
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Weitere Informationen

Corresponding author

T. Takehara, MD, PhD
Department of Gastroenterology and Hepatology
Clinical Research Building
Osaka University Graduate School of Medicine
2-2 Yamadaoka, Suita
Osaka 565-0871
Japan   
Fax: +81-6-6879-3629   

Publikationsverlauf

Publikationsdatum:
28. Mai 2013 (online)

 

A 70-year-old man with abdominal pain and high fever was referred to our hospital because of suspected branch duct intraductal papillary mucinous neoplasm and pancreatolithiasis. Laboratory results showed a total bilirubin of 4.7 mg/dL, slight elevation in the serum pancreatic enzyme level and marked elevation in the serum C-reactive protein level and white blood cell count. Plain computed tomography (CT) showed mild swelling of the pancreas and a 10-mm calcified stone in the head of the pancreas ([Fig. 1]). Due to the presence of obstructive cholangitis and pancreatitis, endoscopic retrograde cholangiopancreatography was carried out for drainage. When a catheter was inserted in the papilla of Vater, there was discharge of a large amount of pus mixed with pancreatic juice ([Fig. 2]). The pancreatic juice was purulent ([Fig. 3], left tube), but the drained bile was not ([Fig. 3], right tube). Klebsiella oxytoca was isolated from the pancreatic juice. Following nasobiliary drainage and medical treatment with antibiotics and gabexate mesilate, the patient recovered quickly with no fever and the abdominal pain. The final diagnosis was acute suppurative pancreatic ductitis (ASPD).

Zoom Image
Fig. 1 Abdominal plain computed tomography (CT) in a 70-year-old man with abdominal pain and high fever, showing a 10-mm calcified stone in the head of the pancreas.
Zoom Image
Fig. 2 Endoscopic view showing discharge of a large amount of pus mixed with pancreatic juice after a catheter was inserted in the papilla of Vater.
Zoom Image
Fig. 3 A cannula was inserted deep into the common bile duct and the pancreatic duct, and bile and pancreatic juice were aspirated, respectively. The pancreatic juice was purulent (left tube), but the bile was normal (right tube).

Weinman [1] reported the first case of ASPD characterized by purulent discharge. Acute suppurative cholangitis due to biliary ductal obstruction is a common disease, but there have been only a few reported cases of ASPD [2] [3]. Drainage of the pancreatic duct is quite effective for relief of ASPD. Therefore an endoscopist should keep in mind the possibility of ASPD in cases suspected of having suppurative cholangitis.

Endoscopy_UCTN_Code_CCL_1AZ_2AM


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Competing interests: None


Corresponding author

T. Takehara, MD, PhD
Department of Gastroenterology and Hepatology
Clinical Research Building
Osaka University Graduate School of Medicine
2-2 Yamadaoka, Suita
Osaka 565-0871
Japan   
Fax: +81-6-6879-3629   


Zoom Image
Fig. 1 Abdominal plain computed tomography (CT) in a 70-year-old man with abdominal pain and high fever, showing a 10-mm calcified stone in the head of the pancreas.
Zoom Image
Fig. 2 Endoscopic view showing discharge of a large amount of pus mixed with pancreatic juice after a catheter was inserted in the papilla of Vater.
Zoom Image
Fig. 3 A cannula was inserted deep into the common bile duct and the pancreatic duct, and bile and pancreatic juice were aspirated, respectively. The pancreatic juice was purulent (left tube), but the bile was normal (right tube).