[Chronic purulent, draining, indolent pancreatic head pancreatitis with extrahepatic cholestasis].
Over the period of two weeks a 19-year-old man developed gradually increasing painless jaundice with dark urine and light-coloured soft stools (6-7 times daily), as well as loss of appetite, nausea and nagging itch. Biochemical tests indicated marked cholestasis (alkaline phosphatase 800 U/l, gamma-GT 206 U/l). Abdominal ultrasound examination revealed high-grade stenosis of the distal choledochal duct caused by an enlargement of the head of the pancreas and computed tomography confirmed a tumour in this location. Endoscopic retrograde cholangiopancreatography demonstrated filiform stenosis of the major pancreatic duct and prepapillary stenosis of the choledochal duct. Several needle biopsies failed to establish a definitive diagnosis. A Whipple operation was performed: the stomach was preserved but about 40% of pancreatic tissue resected. Histologically there was chronic suppurative pancreatitis of the head of the pancreas. The patient was symptom-free 6 months after the operation. The case illustrates that it is not always possible in a painless pancreatic tumour to distinguish between pancreatitis and malignant tumour.
Klinik für Allgemeinchirurgie, Universität Marburg.
H
H
Printz
W
W
Dietz
A
A
Zielke
A
A
Bittinger
M
M
Rothmund
D000328:Adult; D001652:Bile Ducts / Q000000981:diagnostic imaging; D001707:Biopsy, Needle; D002758:Cholangiography; D001651:Cholestasis, Extrahepatic / Q000150:complications*; D002908:Chronic Disease; D003937:Diagnosis, Differential; D006801:Humans; D008297:Male; D010179:Pancreas / Q000000981:diagnostic imaging / Q000601:surgery; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000601:surgery; D010195:Pancreatitis / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography
Chronische eitrig-abszedierende, indolente Pankreaskopfpankreatitis mit extrahepatischer Cholestase.