Gastrointestinal endoscopy · 2024
Clinical insights and management strategies for acute obstructive suppurative pancreatic ductitis: a retrospective study of 82 rare cases.
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Bai Bingqing, Wang Shaofei, Chen Xinwen, Zhang Chenyu, Chen Qiannan, Xu Yan, Li Huihui, Bao Junjun, Mei Qiao, Liu Xiaochang
Аннотация
BACKGROUND AND AIMS: Acute obstructive suppurative pancreatic ductitis (AOSPD) is a rare condition with limited diagnostic and treatment information. In this study, we sought to expand understanding by analyzing the clinical characteristics and management of AOSPD.
METHODS: We analyzed 81 AOSPD cases (1993-2024) from the literature and 1 case from the First Affiliated Hospital of Anhui Medical University. Additionally, 60 acute-on-chronic pancreatitis (CP) cases from our hospital were matched and compared with AOSPD with CP in demographics, laboratory findings, and imaging results.
RESULTS: Sixty-six AOSPD patients (80.5%) were men, and the median patient age was 60 years. CP was present in 60 patients (73.2%), whereas 18 (22.0%) had pancreatic tumors. Pancreatic juice cultures were positive in 47 patients (90.4%). Key treatments included endoscopic pancreatic stent placement in 44 patients (53.7%) and endoscopic nasopancreatic drainage in 31 (37.8%). All follow-up patients showed clinical improvement. Compared with acute-on-CP, AOSPD with CP was more prevalent in older men with a history of pancreaticobiliary intervention, alcohol consumption, and smoking. AOSPD with CP patients typically presented with fever, elevated white blood cell counts, increased C-reactive protein levels, pancreatic stones, and dilated pancreatic ducts. Interestingly, a lower proportion of AOSPD with CP patients exhibited elevated serum amylase levels (P < .05).
CONCLUSIONS: AOSPD primarily affects middle-aged and elderly men with CP and prior pancreaticobiliary intervention. Imaging and pancreatic juice culture aid diagnosis. Compared with acute-on-CP, AOSPD with CP displays distinct clinical characteristics. Timely and accurate diagnosis and treatment can lead to favorable short-term outcomes for patients with AOSPD.
METHODS: We analyzed 81 AOSPD cases (1993-2024) from the literature and 1 case from the First Affiliated Hospital of Anhui Medical University. Additionally, 60 acute-on-chronic pancreatitis (CP) cases from our hospital were matched and compared with AOSPD with CP in demographics, laboratory findings, and imaging results.
RESULTS: Sixty-six AOSPD patients (80.5%) were men, and the median patient age was 60 years. CP was present in 60 patients (73.2%), whereas 18 (22.0%) had pancreatic tumors. Pancreatic juice cultures were positive in 47 patients (90.4%). Key treatments included endoscopic pancreatic stent placement in 44 patients (53.7%) and endoscopic nasopancreatic drainage in 31 (37.8%). All follow-up patients showed clinical improvement. Compared with acute-on-CP, AOSPD with CP was more prevalent in older men with a history of pancreaticobiliary intervention, alcohol consumption, and smoking. AOSPD with CP patients typically presented with fever, elevated white blood cell counts, increased C-reactive protein levels, pancreatic stones, and dilated pancreatic ducts. Interestingly, a lower proportion of AOSPD with CP patients exhibited elevated serum amylase levels (P < .05).
CONCLUSIONS: AOSPD primarily affects middle-aged and elderly men with CP and prior pancreaticobiliary intervention. Imaging and pancreatic juice culture aid diagnosis. Compared with acute-on-CP, AOSPD with CP displays distinct clinical characteristics. Timely and accurate diagnosis and treatment can lead to favorable short-term outcomes for patients with AOSPD.