title: Acute suppuration of the pancreatic duct associated with pancreatic ductal obstruction due to pancreas carcinoma.
abstract: Acute obstructive suppurative cholangitis is a well-known clinical entity; however, acute suppuration of the pancreatic duct in the setting of pancreatic ductal obstruction is an uncommon pancreatic disorder. We report a case of acute suppuration of the pancreatic duct without either a concomitant pancreatic abscess or an infected pseudocyst, presenting as acute relapsing pancreatitis. In this case, the underlying cause of suppuration of the pancreatic duct was pancreatic ductal obstruction and chronic pancreatitis secondary to pancreas head carcinoma along with infection of Escherichia coli. Endoscopic placement of a pancreatic stent resulted in an evacuation of grayish thick pus from the distal pancreatic duct with a dramatic improvement of the disease. This case proposes the concept that acute suppuration of the pancreatic duct is a complex process involving the chronically damaged pancreas, pancreatic outflow obstruction, and subsequent bacterial infection. Antibiotic treatment is effective but temporary; therefore, the immediate drainage of the infected pancreatic duct is mandatory.
authors.affiliation: Department of Transplantation and Digestive Surgery, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto, Nagasaki, Japan. ytajima@net.nagasaki-u.ac.jp
authors.forename: Yoshitsugu
authors.initials: Y
authors.lastname: Tajima
authors.forename: Tamotsu
authors.initials: T
authors.lastname: Kuroki
authors.forename: Seiya
authors.initials: S
authors.lastname: Susumu
authors.forename: Ryuji
authors.initials: R
authors.lastname: Tsutsumi
authors.forename: Amane
authors.initials: A
authors.lastname: Kitasato
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Adachi
authors.forename: Takehiro
authors.initials: T
authors.lastname: Mishima
authors.forename: Takashi
authors.initials: T
authors.lastname: Kanematsu
mesh_terms: D000368:Aged; D002277:Carcinoma / Q000150:complications* / Q000473:pathology / Q000601:surgery; D002760:Cholangiopancreatography, Endoscopic Retrograde; D004322:Drainage; D004927:Escherichia coli Infections / Q000150:complications* / Q000473:pathology / Q000601:surgery; D006801:Humans; D008297:Male; D010183:Pancreatic Ducts / Q000473:pathology* / Q000601:surgery; D010190:Pancreatic Neoplasms / Q000150:complications* / Q000473:pathology / Q000601:surgery; D050500:Pancreatitis, Chronic / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D013492:Suppuration / Q000473:pathology; D014057:Tomography, X-Ray Computed