Pancreatic panniculitis associated with periampullary duodenal diverticulum

Abstract

Introduction. Pancreatic panniculitis is a rare type of lobular panniculitis that manifests as painful erythematous nodules on the skin of the lower extremities. Subcutaneous fat necrosis caused by the release of pancreatic enzymes is the underlying cause of the disease, affecting around 2 to 3% of patients with pancreatic diseases. Case report. We present a case of a 58-year-old male patient who exhibited painful erythematous nodules on the lower extremities and trunk. Laboratory results revealed increased levels of pancreatic enzymes, amylase, and lipase, as well as heightened levels of glucose and inflammation markers. The histological analysis of the skin lesion biopsy revealed the presence of predominantly lobular panniculitis in the hypodermis, areas of fatty tissue necrosis/saponification, and remnants of adipocytes (??ghost cells??). Abdominal CT scan demonstrated periampullary diverticulum of the duodenum, with no signs of pancreatitis or other pancreatic abnormalities. Esophagogastroduodenoscopy showed a wide opening of the periampullary diverticulum in the D2 segment of the duodenum. The patient was successfully treated with pancreatin therapy, resulting in a significant reduction of skin lesions and decreased levels of pancreatic enzymes. Conclusion. Pancreatic panniculitis can be caused by periampullary duodenal diverticula that exert pressure on the pancreatic duct, leading to elevated levels of pancreatic enzymes. Symptomatic duodenal diverticula may be treated with operative or non-operative measures, depending on the individual characteristics of the patient. Treatment of pancreatic panniculitis primarily involves addressing any underlying medical condition.