The given paper describes a case of treating adenocarcinoma of the papilla of Vater diagnosed as the cause after an episode of acute pancreatitis. The etiology of aсute pancreatitis was considered idiopathic until the onset of complaints caused by tumor growth. The volume of radical surgery has changed intraoperatively due to the detection of infected limited necrotic clusters, didn’t diagnosed both laboratory and instrumentally. Pathomorphological conclusion: considering clinical data, low-grade (G3) adenocarcinoma of the major duodenal papilla, which developed from pre-existing tubular villous adenoma of the duodenum or intraampullary papillary neoplasia (IAPN). Predicting the early detection of MNPs after AP episode requires further research by improving imaging techniques, introducing new non-invasive techniques and investigating circulating biomarkers. The scope of surgery for patients with clinically significant complications of tumor growth and identified competing diagnosis at the target site should be individually decided and weighed. Infected pancreatitis in the late stages requires careful diagnosis.

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Дослідження ґрунтується на ретроспективному аналізі морфологічних досліджень 34 хворих на хронічний панкреатит, ускладнений псеводокістами. Дослідження дозволило з’ясувати питання щодо характеру патоморфологічних змін у панкреатичній паренхімі та протоках у хворих на псевдокісти при різному ступені панкреатичного фіброзу. Доведено кореляцію між значним дифузним фіброзом та патоморфологічними змінами у підшлунковій залозі, а саме вірсунголітіазом, паренхіматозним кальцинозом та ретенційними кістами.

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Aim of the study To determine the effect of extrapancreatic infection (EPI) on antibacterial resistance of pancreatic infectious agents in patients with acute infected necrotic pancreatitis Materials and Methods A longitudinal retrospective case-control study was conducted. The Object of the study were the patients with infected acute necrotizing pancreatitis (ANP). The subject of the study was the acquired AMR of pancreatic infection (PI) agents in patients with ANP. The control group included 27 patients who had a positive bacterial culture from sources of PI. 21 patients were included in the risk group, in which the additional source of EPI was recorded. Bacteriological monitoring was conducted in two stages: the primary identification of the agent of PI and the completion of inpatient treatment. Microbiological identification of the pathogen of EPI was performed before the primary determination of the pathogen of PI, and in the interval between stages I and II of the study. According to the results of the resistance profile of PI to AMR, all patients were divided into four clusters: I - patients who identified only antibiotic-sensitive bacterial strains (AMR"-"), II - patients with defined MDR-bacteria (multidrug-resistant), III - patients with XDR-bacteria (extensively drug-resistant), IV - patients with PDR bacteria (pandrug-resistant). Results The presence of EPI in patients with ANP influences the development of AMRs of PI toward increasing XDR and PDR strains (p=0.008 and p=0.04, respectively). In patients with infected ANP with the EPI, the risk of developing XDR infection was 2.4 times higher than the risk of developing this level of AMR in patients with no EPI (RR-2.4 (95% CI-1.16-4.91), p=0.03). EPI increases the risk of PDR PI by 8 times (RR-8.0 (95% CI-1.04-61.5) p=0.04). For each patient with infected ANP with signs of EPI, the risk of developing XDR strains was 36%, and PDR strains - 25%. Conclusions The presence of extrapancreatic sources of infection is a risk factor for development of AMR strains of microorganisms that persist in the sources of pancreatic infection. In this category of patients the risk of identification of extensively resistant strains was increased by 2.4-fold (p=0.03) and PDR strains by 8-fold (p=0.04), compared with patients with infected ANP without EPI.