A Case of Purulent Pancreatic Ductitis Successfully Treated by Endoscopic Stenting

Abstract

A 50‐year‐old male received conservative medical treatment for acute exacerbation of chronic pancreatitis. High fever, abdominal pain, as well as enhancement of inflammatory response and pancreatic enzymes in serum, persisted after treatment for 1 month. Purulent pancreatic fluid was drained by endoscopically placing an 8F plastic stent in the main pancreatic duct, resulting in marked improvement of clinical symptoms. This case appears to provide useful information in considering indications for pancreatic stents.

Clinical features of acute obstructive suppurative pancreatic ductitis: A retrospective review of 20 cases

“…Pancreatic parenchymal enlargement and stranding of the surrounding fat, which are characteristic CT findings of acute pancreatitis, 13 were observed in 3 (15%) and 2 (10%) patients, respectively. The median diameter of the MPD was 7 (range, [3][4][5][6][7][8][9][10][11][12] mm. Pancreatic atrophy and a pancreatic stone in the MPD, which are characteristic findings for chronic pancreatitis, were observed in 7 (35%) and 16 (80%) patients, respectively, and the median diameter of the pancreatic stones was 7.5 (range, 3-22) mm.…”

“…In the present study, prior pancreatic procedures and EPST or EST were performed in 10 (50%) and 7 (35%) of 20 patients, and pancreatic stones in the MPD were observed in 16 (80%) patients. In the previous seven reported cases, two patients underwent previous endoscopic biliary sphincterotomy, one patient underwent previous pancreatic lithotripsy, and one patient underwent previous ERCP. Thus, we consider that a prior pancreatic procedure, the presence of intraductal pancreatic stones, and the presence of CP may have been important contributing factors for AOSPD.…”

“…AOSC is a well‐known clinical entity, characterized by fever, jaundice, and abdominal pain that develops as a result of biliary obstruction and infection in the bile tract . However, AOSPD has not been recognized sufficiently because of its rarity and because alternate names, such as acute suppuration of the pancreatic duct, purulent pancreatic ductitis, and acute suppurative pancreatic ductitis, have been used to describe this condition. To our knowledge, there have been only seven case reports of AOSPD, each of which included only one AOSPD case and no reports of case series concerning AOSPD.…”

“…However, AOSPD has not been recognized sufficiently because of its rarity and because alternate names, such as acute suppuration of the pancreatic duct, purulent pancreatic ductitis, and acute suppurative pancreatic ductitis, have been used to describe this condition. To our knowledge, there have been only seven case reports of AOSPD, each of which included only one AOSPD case and no reports of case series concerning AOSPD. Thus, clinical characteristics, presentation, laboratory findings, imaging findings, and treatment in patients with AOSPD have not yet been examined sufficiently.…”

Endoscopic Approach via the Minor Papilla for the Treatment of Pancreatic Stones

“…Physicians performing ESWL should also acquire the technique of interventional endoscopy for pancreatic stones. We have reported a case of purulent pancreatic ductitis successfully treated by endoscopic stenting for the first time 9. We have experienced several similar cases that were caused by obstruction of the pancreatic stent and impaction of pancreatic stone fragments at the orifice of the MPD.…”