Spontaneous Development of Acute Obstructive Suppurative Pancreatic Ductitis Associated with Pancreatic Carcinoma: A First Case Report

Abstract

A 68-year-old man with a history of diabetes mellitus was admitted to our hospital with a diagnosis of acute pancreatitis. Abdominal computed tomography revealed a suspicious tumor in the body of the pancreas, along with a dilated main pancreatic duct and edema of the pancreatic tail. Endoscopic retrograde pancreatography was performed after treating the patient's pancreatitis. When a cannula tip was advanced beyond the stenosis, deep into the distal pancreatic duct, thick white pus was evacuated. A bacteriological examination of the aspirated pancreatic juice revealed Enterobacter cloacae, and a cytological examination revealed adenocarcinoma. The diagnosis was acute obstructive suppurative pancreatic ductitis associated with pancreatic carcinoma.

Case Report: Pancreatic adenocarcinoma presenting as acute obstructive suppurative pancreatic ductitis

“…AOSPD presentation overlaps with cholangitis and this mimicry makes misdiagnosis or non-recognition as a separate clinical entity difficult. AOSPD presentation varies from acute to chronic, the most common symptom being abdominal pain [1][2][3][4][5][8][9][10][11][12] . Less commonly, it may also present as sepsis or septic shock [1][2][3][4] .…”

“…Treatment is through source control via ERCP drainage and appropriate antibiotic administration. Notably, endoscopic naso-pancreatic drainage (ENPD) was additionally performed following ERCP in one reported case 11 . At this time, there are no established guidelines for the duration of therapy.…”

“…The distinguishing feature is a lack of pseudocyst, abscess, or necrosis formation. Literature remains sparse in the domain of AOSPD, with a recent literature search only mentioning this entity in over 29 cases to date [1][2][3][4][5][6][7][8][9][10][11][12] . Pancreatic malignancy is also known to promote AOSPD by obstructing pancreaticobiliary secretion outflow ensuing in subsequent infection 2,9 .…”

Rare cause of recurrent fever of unknown origin: Acute obstructive suppurative pancreatic ductitis after pancreaticojejunostomy

“…4 Although there is no standard treatment, prompt administration of antibiotics and pancreatic duct drainage is the mainstay of the treatment. 3,5 In this case, the patient suffered from recurrent FUO for 3 years. As this case indicates, AOSPD should be considered in the differential diagnosis of FUO, particularly in patients with previous history of pancreatic intervention.…”

“…1,2 Most of the AOSPD patients present with high fever and elevated CRP levels. 3,4 Unlike pancreatitis, pancreatic enzymes are often normal or only slightly elevated in patients with pancreatic ductitis. 3 The diagnosis of AOSPD is confirmed by the finding of pancreatic duct obstruction with evidence of infection, such as positive pancreatic juice culture or purulent pancreatic juice.…”