A pancreatic abscess 7 years after a pancreatojejunostomy for calcifying chronic pancreatitis.
We present herein a case of a 75-year-old Japanese man who had developed a pancreatic abscess 7 years after a longitudinal pancreatojejunostomy for chronic pancreatitis. The patient, a heavy drinker of alcohol, underwent surgical decompression of a ductal obstruction to relieve persistent abdominal pain due to severely calcifying chronic pancreatitis. After the surgery, he stopped drinking alcohol and was treated with insulin to control secondary diabetes mellitus. Thereafter, his symptoms disappeared. Seven years after the surgery, however, he was hospitalized due to obstructive jaundice, high-grade fever, and right hypochondria pain. Ultrasound and computed tomographic scans of the abdomen both disclosed a cystic mass, approximately 6 cm in size, in the pancreatic head. Magnetic resonance imaging strongly suggested a pancreatic abscess with necrotic fluid and debris. First, percutaneous transhepatic cholangiodrainage (PTCD) was done to treat the progressively obstructive jaundice. Subsequently, fine-needle aspiration of the pancreatic abscess was performed under ultrasound guidance. Enterococcus avium and Klebsiella oxytoca were revealed by culture of abscess aspirates. He was successfully cured by treatment with both appropriate antibiotic and continuous PTCD for the obstructive jaundice.
Suzuki
Asako
A
Department of Internal Medicine, Doto Hospital, A Not-For-Profit Medical Foundation, N17, E14, Higashi-ku, Sapporo 065-8555, Japan.
Matsunaga
Takahiro
T
Aoki
Shigeo
S
Hirayama
Toyoko
T
Nakagawa
Naoaki
N
Shibata
Kaori
K
Yabana
Tsuyoshi
T
Kawasaki
Hiroyuki
H
Takasaka
Hajime
H
Sasaki
Kazuaki
K
Katsuramaki
Tadashi
T
Mukaiya
Mitsuhiro
M
Hirata
Koichi
K
Imai
Kohzoh
K
D000038:Abscess / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D000368:Aged; D000900:Anti-Bacterial Agents; D002114:Calcinosis / Q000175:diagnosis / Q000601:surgery*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D001651:Cholestasis, Extrahepatic / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D002908:Chronic Disease; D003131:Combined Modality Therapy; D004322:Drainage / Q000379:methods; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D007710:Klebsiella Infections / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D008297:Male; D010193:Pancreaticojejunostomy / Q000009:adverse effects / Q000379:methods*; D010195:Pancreatitis / Q000175:diagnosis / Q000601:surgery*; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler
D000900:Anti-Bacterial Agents