Chronic pancreatitis

Two patients presented with dyspnea and signs of chronic pancreatitis. Patient B had pleural effusion on chest X-ray. Patient A developed pleural effusion during the course of disease. On further analysis these pleural effusions showed elevated amylase concentrations. This finding suggested the diagnosis of a pancreaticopleural fistula which was confirmed by magnetic resonance cholangiopancreatography. Because of the distinct localization of the fistulas the patients were treated differently. In patient A an endoprosthesis was successfully placed in the pancreatic duct, and patient B underwent distal pancreatic resection. Considering the rarity of pancreaticopleural fistula, there is no consensus on diverse aspects of treatment, such as length of treatment with octreotide. However, a rationale for the distinction between fistulas suited for treatment with endoprosthesis or surgery seems to provide some grip.

Section: Discussionmentioning

confidence: 99%

Two Patients with Chronic Pancreatitis Complicated by a Pancreaticopleural Fistula

Kiewiet¹,

Moret

Blok

et al. 2009

“…AIP is a systemic disease which, in addition to the pancreas, is known to affect multiple organs such as bile duct, cervical and abdominal lymph nodes, salivary gland, retroperitoneum, peripancreatic artery and vein [ 1 , 6 , 7 ]. Usually, this type of pancreatitis recovers structurally and functionally when the ductal obstruction is removed or the inflammation disappears after steroid administration [ 8 ]. According to a Japanese nationwide survey [ 9 ], the incidence of AIP was 0.82 per 100,000 people in 2002, with a higher ratio of males (2.85 times that of females).…”

Section: Discussionmentioning

confidence: 99%

Autoimmune Pancreatitis Accompanied by Cholecystitis, Periaortitis and Pseudotumors of the Liver

Matsubayashi¹,

Furukawa²,

Uesaka³

et al. 2008

A variety of extrapancreatic lesions have been associated with autoimmune pancreatitis (AIP), and these lesions can be difficult to diagnose. We report a patient referred to Shizuoka Cancer Center with the diagnosis of a possible biliary carcinoma with liver metastasis who was shown to have AIP accompanied by pseudotumors of liver. Clinical imaging revealed diffuse enlargement of the head of the pancreas with irregular narrowing of the main pancreatic duct and inferior common bile duct, multiple liver masses, mediastinal lymphadenopathy, and thickening of the wall of the gallbladder and abdominal aorta. Cytology and biopsy from the pancreaticobiliary tract was negative for malignancy. Serum carcinoembryonic antigen (CEA) and carbohydrate antigen (CA19-9) levels were in the normal range, but soluble interleukin 2 receptor (sIL2R), IgG4 and antinuclear antibody were abnormally high (sIL2R: 2,550 U/ml; IgG4: 764 mg/dl). Corticosteroid therapy was effective and these abnormal findings all improved. This case demonstrates the clinical importance of AIP accompanied by other systemic disorders in the differential diagnosis of patients with a pancreatic mass lesion.

“…It is a fact that many causes exist for pancreatitis, however VPA is most suspected as a cause of pancreatitis in this case. Furthermore, it is suggested that numerous pancreatic complications and/or pancreatitis-associated diseases may affect the course and determine the prognosis of chronic pancreatitis, and biological markers and/or imaging procedure development were needed to detect chronic pancreatitis at its reversible stage [5, 6]. Thrombosis of the splenic vein has been reported in 7–20% of patients with chronic pancreatitis.…”

Section: Discussionmentioning

confidence: 99%

Gastric Varices with Remarkable Collateral Veins in Valpronic Acid-Induced Chronic Pancreatitis

Hattori

Higurashi

Takahashi³

et al. 2008

Valproic acid (VPA) is a commonly prescribed and approved treatment for epilepsy, including Angelman syndrome, throughout the world. However, the long-term administration of drugs like VPA is associated with the possible development of gastric varices and splenic obstruction as a result of chronic pancreatitis. Such cases can be difficult to treat using endoscopy or interventional radiology because of hemodynamic abnormalities; therefore, surgical treatment is often necessary.