[A patient with sclerosing autoimmune pancreaticocholangitis as the cause of recurrent cholangitis following a pylorus-sparing pancreaticoduodenectomy].
A pylorus-sparing pancreaticoduodenectomy was performed in a 67-year-old man because of indications for a carcinoma of the distal common bile duct. Histology of the postoperative specimen, however, revealed a sclerosing inflammation of the distal common bile duct and the surrounding pancreatic parenchyma. Initial postoperative recovery was followed by recurrent cholangitis. Stenosis of the choledocho-jejunostomy could not be demonstrated. Instead, repeated endoscopic retrograde cholangiopancreaticography revealed extensive sclerosis of the intrahepatic bile ducts, which suggested a sclerosing cholangitis associated with an autoimmune pancreatitis: sclerosing autoimmune pancreaticocholangitis. This disorder was recently described; it is characterised by a disorder in the pancreas that is indistinguishable from malignancy by imaging techniques and that is followed by a sclerosing inflammation of the bile ducts. The disease responds well to steroids. The patient described demonstrated a complete clinical and biochemical recovery after initiation ofprednisone therapy.
Wallis de Vries
B M
BM
Deventer Ziekenhuis, Postbus 5ooi, 7400 GC Deventer. b.wallisdevries@dz.nl
ter Borg
E
E
Eeftinck Schattenkerk
M
M
Eddes
E H
EH
D000368:Aged; D001327:Autoimmune Diseases / Q000150:complications*; D001650:Bile Duct Neoplasms / Q000175:diagnosis / Q000473:pathology; D002760:Cholangiopancreatography, Endoscopic Retrograde; D015209:Cholangitis, Sclerosing / Q000209:etiology* / Q000473:pathology; D003135:Common Bile Duct / Q000473:pathology; D003937:Diagnosis, Differential; D006801:Humans; D008297:Male; D016577:Pancreaticoduodenectomy; D010195:Pancreatitis / Q000150:complications*; D012008:Recurrence