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

Taha Sheikh,Ali Nawras,Jordan Burlen,Toseef Javaid,Syed Hamza Bin Waqar

doi:10.12688/f1000research.29992.1

Abstract

Acute obstructive suppurative pancreatic ductitis (AOSPD) is a rare form of infection primarily arising within the pancreatic duct in the setting of chronic pancreatitis. We present a case of AOSPD precipitated by obstructive adenocarcinoma of pancreatic head in an elderly woman with a past medical history of chronic pancreatitis, alcohol use disorder and, advanced dementia, who developed progressive abdominal pain during her hospital admission for urinary tract infection. Endoscopic retrograde cholangiopancreatography (ERCP) with balloon sweep of pus and stent placement resulted in prompt abdominal pain resolution. Our case highlights a rare presentation of AOSPD as a harbinger of pancreatic malignancy.

Highlights

Acute obstructive suppurative pancreatic ductitis (AOSPD), first described in 1995, is a rare consequence of chronic pancreatitis characterized by an acute infection of the pancreatic ducts while sparing pancreatic parenchyma
Pancreatic malignancy is known to promote AOSPD by obstructing pancreaticobiliary secretion outflow ensuing in subsequent infection[2,9]
We describe a case of AOSPD precipitated by underlying pancreatic adenocarcinoma

Summary

Introduction

AOSPD, first described in 1995, is a rare consequence of chronic pancreatitis characterized by an acute infection of the pancreatic ducts while sparing pancreatic parenchyma. Magnetic resonance cholangiopancreatography (MRCP) was performed, which showed chronic pancreatitis and a 1 cm calculus in the main pancreatic duct; we pursued no intervention She again had an episode two months prior with elevated white cell count, which responded to a short antibiotic course, but no infection source was found. Abdominal computed tomography (CT) performed to look for a possible abscess revealed a 3cm obstructive mass in the pancreatic head, suspicious for malignancy with dilation of CBD and pancreatic duct (PD) measuring 16mm and 11mm respectively. An abdominal ultrasound performed showed a 14mm stone in the pancreatic head with a dilated pancreatic, common hepatic and common bile duct (CBD), measuring 11mm, 9mm, and 11mm respectively (Figure 1 and Figure 2).

Discussion

Weinman DS