Acute Obstructive Suppurative Pancreatic Ductitis in an Asymptomatic Patient

Abstract

Acute obstructive suppurative pancreatic ductitis (AOSPD), defined as suppuration from the pancreatic duct without associated pseudocyst, abscess, or necrosis, is a rare complication of chronic pancreatitis. We present the first case of AOSPD in an asymptomatic patient with a polymicrobial infection and review the literature on this rare clinical entity.

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.…”

“…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.…”

Acute Obstructive Suppurative Pancreatic Ductitis

“…While acute cholangitis secondary to obstruction of the biliary tree is a well-known condition, suppuration of the pancreatic duct without evidence of necrotic pancreatic tissue, abscess, or pseudocyst is rare. 1 - 3 Typically, patients present with abdominal sepsis and elevated inflammatory markers; however, asymptomatic cases have been reported. 1 , 4 Acute obstructive suppurative pancreatic ductitis (AOSPD) is a rare condition defined as suppuration of the pancreatic duct without concomitant pancreatic cyst, abscess, or necrosis.…”

“… 1 , 4 Acute obstructive suppurative pancreatic ductitis (AOSPD) is a rare condition defined as suppuration of the pancreatic duct without concomitant pancreatic cyst, abscess, or necrosis. 1 …”