Six cases of acute obstructive suppurative pancreatic ductitis

We experienced 6 cases of chronic pancreatitis with calculus exhibiting pus-containing pancreatic juice on endoscopic retrograde cholangiopancreatography (ERCP), along with hyperpyrexia, abdominal pain, and systemic inflammatory response. We defined this disease state as acute obstructive suppurativ...

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Published inSuizo Vol. 27; no. 6; pp. 755 - 761
Main Authors KIKUYAMA, Masataka, KUROGAMI, Takafumi, CHIBA, Tsutomu, KODAMA, Yuzo, MORITA, Toshihiro, OTA, Yuji, SHIGETOMO, Miki, MATSUMURA, Kazunori
Format Journal Article
LanguageJapanese
Published Japan Pancreas Society 2012
Subjects
Acute obstructive suppurative pancreatic ductitis
Chronic pancreatitis
Pancreatic calculus
Online AccessGet full text
ISSN0913-0071
1881-2805
1881-2805
DOI10.2958/suizo.27.755

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Abstract We experienced 6 cases of chronic pancreatitis with calculus exhibiting pus-containing pancreatic juice on endoscopic retrograde cholangiopancreatography (ERCP), along with hyperpyrexia, abdominal pain, and systemic inflammatory response. We defined this disease state as acute obstructive suppurative pancreatic ductitis (AOSPD) based on the similarity to acute obstructive suppurative cholangitis (AOSC). Five of 6 patients with positive pancreatic juice culture for indigenous intestinal bacteria were successfully treated with endoscopic naso-pancreatic drainage (ENPD). The other one case underwent surgery because of difficulty for endoscopic treatment. Thus, in cases of acute exacerbation of chronic pancreatitis with pancreatic calculus and hyperpyrexia, the possibility of AOSPD and the indication of ENPD should be considered.
AbstractList We experienced 6 cases of chronic pancreatitis with calculus exhibiting pus-containing pancreatic juice on endoscopic retrograde cholangiopancreatography (ERCP), along with hyperpyrexia, abdominal pain, and systemic inflammatory response. We defined this disease state as acute obstructive suppurative pancreatic ductitis (AOSPD) based on the similarity to acute obstructive suppurative cholangitis (AOSC). Five of 6 patients with positive pancreatic juice culture for indigenous intestinal bacteria were successfully treated with endoscopic naso-pancreatic drainage (ENPD). The other one case underwent surgery because of difficulty for endoscopic treatment. Thus, in cases of acute exacerbation of chronic pancreatitis with pancreatic calculus and hyperpyrexia, the possibility of AOSPD and the indication of ENPD should be considered.
Author CHIBA, Tsutomu
OTA, Yuji
KUROGAMI, Takafumi
MORITA, Toshihiro
MATSUMURA, Kazunori
KODAMA, Yuzo
SHIGETOMO, Miki
KIKUYAMA, Masataka
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  fullname: KODAMA, Yuzo
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  fullname: MORITA, Toshihiro
  organization: Department of Gastroenterology, Shizuoka General Hospital
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  fullname: OTA, Yuji
  organization: Department of Gastroenterology, Kyoto University
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  fullname: SHIGETOMO, Miki
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10.1055/s-2001-13695
10.1620/tjem.221.197
10.1016/S1091-255X(97)80057-1
10.1016/0002-9610(82)90008-3
10.1128/IAI.23.2.403-411.1979
10.1016/S0016-5107(03)02719-6
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– reference: 14) Costamagna G, Mutignani M, Ingrosso M, et al. Endoscopic treatment of postsurgical external pancreatic fistulas. Endoscopy 2001; 33: 317-22.
– reference: 10) 佐藤晃彦, 下瀬川徹. 膵炎と腸内細菌. 臨床消化器内科 2007; 9: 1233-7.
– reference: 12) 野口和典, 居石哲治, 笹冨くるみ, 他. 腸管での吸収の機序と肝病変における変化,エンドトキシンと肝胆膵疾患. 肝胆膵 1997; 35: 295-302.
– reference: 13) Kozarek RA, Ball TJ, Patterson DJ, et al. Transpapillary stenting for pancreaticocutaneous fistulas. J Gastrointest Surg 1997; 1: 357-61.
– reference: 7) 山根幸雄, 加嶋 敬. 腹痛―膵石. 肝胆膵 2002; 44: 165-70.
– reference: 1) 馬場忠雄, 新谷 寛. 慢性膵炎の症状と臨床. 現代医療 1997; 29: 2042-9.
– reference: 3) 大田悠司, 菊山正隆, 笹田雄三, 他. 膵石症経過中の化膿性閉塞性膵管炎発症について. 日本消化器病学会雑誌 2007; 104: A731.
– reference: 11) 居石哲治, 佐田通夫, 野口和典. エンドトキシンの腸管からの透過・吸収. 消化器科 2003; 37: 1-6.
– reference: 4) 大田悠司, 菊山正隆, 笹田雄三. 膵石症に合併した急性化膿性膵管炎―当院での経験とその病態についての考察―. Gastroenterol Endosc 2009; 51（Suppl 1）: 681.
– reference: 5) Ota Y, Masamune A, Inui K, Kume K, Shimosegawa T, Kikuyama M. Phenotypic variability of the homozygous IVS3+2T>C mutation in the serine protease inhibitor Kazal type 1 (SPINK1) gene in patients with chronic pancreatitis. Tohoku J Exp Med 2010; 221: 197-201.
– reference: 15) Miyachi A, Kikuyama M, Matsubayashi Y, et al. Successful treatment of pancreaticopleural fistula by nasopancreatic drainage and endoscopic removal of pancreatic duct calculi: a case report. Gastrointest Endosc 2004; 59: 454-7.
– reference: 9) Berg RD, Garlington AW. Translocation of certain indigenous bacteria from the gastrointestinal tract to the mesenteric lymph nodes and other organs in a gnotobiotic mouse model. Infect Immun 1979; 23: 403-11.
– reference: 2) 飯尾悦子, 大原弘隆, 中沢貴宏, 他. 膵管ステンティングとESWLが有効であった急性膿性膵管炎を併発した膵石症の1例. 肝胆膵治療研究会誌 2004; 1: 77-83.
– reference: 6) Aoki S, Okayama Y, Ohara H, et al. A case of purulent pancreatic ductitis successfully treated by endoscopic stenting. Dig Endosc 2000; 12: 341-4.
– reference: 16) 菊山正隆, 笹田雄三, 小出茂樹, 他. 術後胃（Billroth II，Roux-en-Y再建胃）に対するERCP:前方斜視鏡を用いたERCP. 胆と膵 2009; 30: 1205-12.
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  doi: 10.1046/j.1443-1661.2000.00072.x
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  doi: 10.1055/s-2001-13695
– ident: 5
  doi: 10.1620/tjem.221.197
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– ident: 11
– ident: 10
– ident: 13
  doi: 10.1016/S1091-255X(97)80057-1
– ident: 16
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  doi: 10.1016/0002-9610(82)90008-3
– ident: 9
  doi: 10.1128/IAI.23.2.403-411.1979
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  doi: 10.1016/S0016-5107(03)02719-6
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Snippet We experienced 6 cases of chronic pancreatitis with calculus exhibiting pus-containing pancreatic juice on endoscopic retrograde cholangiopancreatography...
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SubjectTerms Acute obstructive suppurative pancreatic ductitis
Chronic pancreatitis
Pancreatic calculus
Title Six cases of acute obstructive suppurative pancreatic ductitis
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