1/27. Regression of pancreatic fibrosis after steroid therapy in patients with autoimmune chronic pancreatitis. Autoimmune chronic pancreatitis (AICP) is a clinically attractive entity because of its dramatic response to steroid therapy. Reported cases of AICP until now have focused on mainly clinical, radiologic, and laboratory features with steroid therapy. There are, however, few reports that demonstrate histologic recovery, especially regression of pancreatic fibrosis in patients with AICP. fibrosis in chronic pancreatitis is generally believed to be irreversible. Our observation of reversibility of pancreatic fibrosis is, therefore, noteworthy. We illustrate this with 2 cases of AICP in which pancreatic fibrosis as well as inflammatory infiltration regressed after a short course of oral steroid therapy. ( info) |
2/27. Groove pancreatitis and pancreatic heterotopia in the minor duodenal papilla. Groove pancreatitis is a rare form of segmental chronic pancreatitis that involves the anatomic space between the head of the pancreas, the duodenum, and the common bile duct. We report 2 cases of groove pancreatitis with pancreatic heterotopia in the minor papilla. patients were a 44-year-old woman and a 47-year-old man. Both had a past history of alcohol consumption and presented with abdominal pain, vomiting, and weight loss caused by duodenal stenosis. Abdominal computed tomography revealed thickening of the duodenal wall and enlargement of the pancreatic head in both patients. In 1 patient, ultrasound endoscopy showed a dilated duct in the head of the pancreas. pancreaticoduodenectomy was performed to rule out pancreatic adenocarcinoma and because of the severity of the symptoms. In both cases, gross and microscopic examinations showed fibrous scar of the groove area. The Santorini duct was dilated and contained protein plugs in both patients, with abscesses in 1 of them. In both cases, there were microscopic foci of heterotopic pancreas with mild fibrosis in the wall of the minor papilla. Groove pancreatitis is often diagnosed in middle-aged alcoholic men presenting with clinical symptoms caused by duodenal stenosis. The pathogenesis of this rare entity could be because of disturbance of the pancreatic secretion through the minor papilla. pancreatitis in heterotopic pancreas located in the minor papilla and chronic consumption of alcohol seem to be important pathogenic factors. ( info) |
3/27. Intense PET signal in the degenerative necrosis superimposed on chronic pancreatitis. Although fluorine-18 deoxyglucose-positron emission tomography (FDG-PET) is a sensitive diagnostic modality in detecting malignant tumors, differential diagnosis of malignant tumors from inflammatory lesion is challenging. We experienced a case of acute degenerative necrosis superimposed on chronic pancreatitis, which was difficult to distinguish from pancreatic cancer. The patient was a 66-year-old man with a complaint of upper abdominal pain. Abdominal computed tomography revealed low-density masses in the head and body of the pancreas. FDG-PET revealed intense accumulations at the head and body of the pancreas (mean standard uptake value for the head and body pancreatic tumors was 4.1 and 6.7, respectively) corresponding to the 2 tumors detected by computed tomography. Because of a possible malignant pancreatic tumor, the patient underwent pylorus-preserving pancreatoduodenectomy. Histologic examination of the resected specimen revealed a characteristic of chronic pancreatitis in a nontumorous area. Two tumors detected by FDG-PET consisted of degenerative necrosis surrounded by granulation tissue. The amount of granulation tissue was correlated to the levels of standard uptake value. No malignant tumors were observed. This case suggests a limitation of FDG-PET in distinguishing malignant neoplastic lesions in the pancreas, especially from acute degenerative changes in chronic pancreatitis. Repetitive PET examination is recommended for the accurate diagnosis. ( info) |
4/27. Chronic calcifying pancreatitis and systemic lupus erythematous. Gastrointestinal manifestations are common in systemic lupus erythematous (SLE), occurring in 35% to 40% of patients at some stage of their illness. SLE is an uncommon etiology of pancreatic disease. Only 3 cases of chronic pancreatitis associated with SLE have been reported in adults. We report the case of a 59-year-old white woman with a history of mechanic aortic valve replacement and SLE presented to the emergency unit for acute pancreatitis with no other identifiable etiology. ( info) |
5/27. Acute retinopathy following pancreatic head resection for chronic pancreatitis: a rare, severe complication. CONTEXT: Chronic pancreatitis is a pancreatic disorder affecting endocrine and exocrine pancreatic functions with a variety of mainly abdominal symptoms. CASE REPORT: We report the rare complication of acute retinopathy with visual loss following pancreatic head resection due to chronic pancreatitis. CONCLUSIONS: Acute retinal dysfunction is a rare severe complication of acute and chronic pancreatitis. Early recognition and therapy are of utmost importance in restoring normal visual acuity and avoiding irreversible damage. ( info) |
6/27. Autoimmune pancreatitis with hepatic inflammatory pseudotumor. We report a case of autoimmune pancreatitis (AIP) with hepatic inflammatory pseudotumor (IP). The patient was clinically diagnosed as having multiple metastatic tumors originated from cholangiocellular carcinoma as well as autoimmune pancreatitis and underwent left lobectomy of the liver. Histological examination showed a diffuse or dense lymphoplasmacytic infiltration with obliterating phlebitis but an absence of neoplastic proliferation both in the liver tumor and in the biopsy specimen of the pancreas. Abundant IgG4-positive plasma cells were seen in the lesions. This is the first case report that shows a simultaneous occurrence of hepatic IP and AIP, suggesting that these lesions appeared on the background of the recently proposed entity of IgG4-related systemic disease. ( info) |
7/27. A rare cause of mediastinal expansion with a massive pleural effusion. The authors present a case of a 53 year old woman, who was admitted to hospital because of an unusual cause of massive pleural effusion. During diagnostic examination the mediastinal propagation of the pancreatic pseudocyst was discovered as a complication of the chronic calcifying pancreatitis. The patient was operated on and the pseudocyst was resolved by Roux-en-Y cystjejunostomy. The diagnostics and treatment of this unusual pancreatic pseudocyst spreading is discussed. ( info) |
8/27. Surgical management of a pancreaticopleural fistula in a child with chronic pancreatitis. Chronic pancreatitis in children rarely results in the development of a recalcitrant pleural effusion, secondary to a connection between the pleural cavity and the pancreas. We describe such a case and the curative surgical therapy and include a brief discussion of the relevant medical literature as it pertains to this complication in the pediatric population. ( info) |
9/27. Severe osteomalacia in a patient with idiopathic chronic pancreatitis. We report a 30-year-old woman who was confined to a wheelchair because of severe myopathy. She was first seen by a neurologist because of a convulsive syndrome of unknown etiology when she was nine. She was started on anticonvulsive drugs but the drug was stopped when her serum calcium level was found to be very low. She had a history from childhood of steatorrhea and abdominal pain after a fatty meal and became vegetarian at age five years. She worked in a hospital as a nurse and at home her living room received no direct sunlight. As a result of these conditions osteomalacia progressed. We believe an awareness of chronic pancreatitis (CP) during childhood could have prevented the consequences of the disease in this case. ( info) |
10/27. Purtscher's retinopathy that occurred 6 months before acute pancreatitis. PURPOSE: To report Purtscher's retinopathy in a patient with chronic pancreatitis 6 months before the development of fulminant acute pancreatitis. DESIGN: Observational case report. methods: review of clinical chart, photographs, fluorescein angiography, and optical coherence tomography. RESULTS: A 45-year-old man with a history of alcohol abuse with a 3-day history of decreased vision in both eyes was examined. Diffuse retinal whitening and intraretinal hemorrhages that were consistent with Purtscher's retinopathy were present in both eyes. serum amylase and lipase levels were normal. Six months later, he experienced intractable abdominal pain. serum amylase and lipase levels were elevated markedly. Abdominal computed tomography and endoscopic retrograde cholangiopancreatography confirmed acute pancreatitis, with evidence of coexisting chronic pancreatitis. His funduscopic examination after the development of acute pancreatitis was improved, with almost complete resolution of retinal whitening and hemorrhages. visual acuity remained poor because of retinal ischemia. CONCLUSIONS: Purtscher's retinopathy can be associated with chronic pancreatitis and can precede the development of fulminant acute pancreatitis. ( info) |