Medicine · 2025
Chronic pancreatitis with pancreatic duct stones complicated by acute obstructive suppurative pancreatic ductitis: Report of a case and review of the literature.
СтатьяКлинический случайОбзорНазвание и аннотация: Перевод в очереди
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Ren Xia, Zhang Wendi, Wang Jinbo, Wu Zongyang, Wu Yifeng, Feng Jiye
Аннотация
RATIONALE: Acute obstructive suppurative pancreatic ductitis (AOSPD) is an exceedingly rare surgical pancreatic condition. This case report aims to elucidate the clinical features and treatment strategies for AOSPD.
PATIENT CONCERNS: The patient, a 52-year-old male, has a known medical history of chronic pancreatitis, pancreatic duct stones, and type 2 diabetes. In 2022, he received treatment at our hospital through extracorporeal shock wave lithotripsy and endoscopic retrograde cholangiopancreatography. However, in 2023, following a large meal, he experienced persistent upper abdominal pain lasting for 3 days. This episode caused him significant concern about his health, as he began to suspect a potential recurrence of his previous conditions.
DIAGNOSES: Following the onset of abdominal pain, the patient underwent an emergency endoscopic retrograde cholangiopancreatography at our facility. During the procedure, pus was successfully aspirated from the pancreatic duct for bacterial culture. Subsequent analysis revealed the presence of Escherichia coli and Proteus mirabilis, which provided conclusive evidence supporting a diagnosis of AOSPD.
INTERVENTIONS: We promptly relieved the pancreatic duct obstruction in the patients and treated them with antibiotics.
OUTCOMES: AOSPD primarily affects middle-aged/elderly males, often with chronic pancreatitis, pancreatic duct stones, or pancreatic tumors. Clinical manifestations are nonspecific, with abdominal pain and fever as the most common symptoms. Pancreatic duct obstruction and infection underlie the pathology, making pancreatic duct patency and drainage critical for effective treatment.
LESSONS: AOSPD is a rare condition attributed to its low incidence and the challenges associated with diagnosis. AOSPD should be considered in patients with chronic pancreatitis and duct obstruction who present with fever or abdominal pain. Early duct drainage is crucial; however, standardized diagnostic criteria and treatment protocols are still lacking. Further research is warranted.
PATIENT CONCERNS: The patient, a 52-year-old male, has a known medical history of chronic pancreatitis, pancreatic duct stones, and type 2 diabetes. In 2022, he received treatment at our hospital through extracorporeal shock wave lithotripsy and endoscopic retrograde cholangiopancreatography. However, in 2023, following a large meal, he experienced persistent upper abdominal pain lasting for 3 days. This episode caused him significant concern about his health, as he began to suspect a potential recurrence of his previous conditions.
DIAGNOSES: Following the onset of abdominal pain, the patient underwent an emergency endoscopic retrograde cholangiopancreatography at our facility. During the procedure, pus was successfully aspirated from the pancreatic duct for bacterial culture. Subsequent analysis revealed the presence of Escherichia coli and Proteus mirabilis, which provided conclusive evidence supporting a diagnosis of AOSPD.
INTERVENTIONS: We promptly relieved the pancreatic duct obstruction in the patients and treated them with antibiotics.
OUTCOMES: AOSPD primarily affects middle-aged/elderly males, often with chronic pancreatitis, pancreatic duct stones, or pancreatic tumors. Clinical manifestations are nonspecific, with abdominal pain and fever as the most common symptoms. Pancreatic duct obstruction and infection underlie the pathology, making pancreatic duct patency and drainage critical for effective treatment.
LESSONS: AOSPD is a rare condition attributed to its low incidence and the challenges associated with diagnosis. AOSPD should be considered in patients with chronic pancreatitis and duct obstruction who present with fever or abdominal pain. Early duct drainage is crucial; however, standardized diagnostic criteria and treatment protocols are still lacking. Further research is warranted.