A Case of Non‐Alcoholic Pancreatitis Treated with Steroid Followed‐up Using Intraductal Ultrasonography and Endoscopic Retrograde Pancreatography

Abstract

Abstract:A 42‐year‐old man with jaundice was found to have a pancreatic mass in the head by ultrasonography. Endoscopic retrograde cholangiopancreatography (ERCP) showed a segmental narrowing of the main pancreatic duct (MPD) with a mild upstream dilatation and an extrinsic stenosis of the inferior common bile duct (CBD). lntraductal ultrasonography (IDUS) showed a diffuse hypoechoic area with echogenic spots surrounding the narrowed MPD and the stenotic CBD. He was suspected of having autoimmune pancreatitis because of a characteristic pancreatogram, and 30 mg/day predniso‐lone was started. Two weeks later, the narrowing of the MPD and the stenosis of the CBD improved dramatically. But the hypoechoic area remained separate from the MPD with a fine reticular pattern on the inside. It completely disappeared in the eighth week. The diachronic changes in the IDUS were characteristic in that the hypoechoic area, which initially surrounded the MPD, disappeared near the MPD, followed by a distant area. This might explain the discrepancy between the images of ERCP and IDUS in the second week of steroid therapy.