Alcoholic severe acute pancreatitis with positive culture of pancreatic juice treated by nasopancreatic drainage.
BACKGROUND
Severe acute pancreatitis (SAP) is a serious disease associated with alcoholism and has a high mortality rate. Effective treatments have not been established.


METHODS
A 58-year-old man was admitted due to alcoholic SAP. Endoscopic retrograde cholangiopancreatography revealed pancreatic calculi at the pancreas head and a stricture in the pancreatic duct from the pancreas head to the body. Endoscopically, nasopancreatic drainage (NPD) was placed through the minor papilla to the pancreas tail beyond the stricture.


RESULTS
Pancreatic juice culture was positive for Streptococcus and Enterobacter. The day after NPD, upper abdominal pain was relieved. After changing NPD to a pancreatic stent, the patient was discharged on day 21 post-NPD.


CONCLUSIONS
Alcoholic SAP may reflect aggravation of chronic pancreatitis. The possibility of acute bacterial inflammation should be considered in all cases of chronic alcoholic pancreatitis who present with severe features of inflammation, even in the early stages of an attack. Treatment of this subset of cases by drainage could be of great importance and NPD may be the preferred method.
Department of Gastroenterology, Shizuoka General Hospital, Shizuoka, Japan. Electronic address: kikuyama110@yahoo.co.jp.
Masataka
M
Kikuyama
Department of Gastroenterology, Shizuoka General Hospital, Shizuoka, Japan.
Kazumasa
K
Nakamura
Department of Gastroenterology, Shizuoka General Hospital, Shizuoka, Japan.
Takafumi
T
Kurokami
D000208:Acute Disease; D002760:Cholangiopancreatography, Endoscopic Retrograde; D004322:Drainage / Q000379:methods; D016972:Enterobacter cloacae / Q000302:isolation & purification*; D004756:Enterobacteriaceae Infections / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010189:Pancreatic Juice / Q000382:microbiology*; D019512:Pancreatitis, Alcoholic / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy*; D015607:Stents; D013290:Streptococcal Infections / Q000150:complications / Q000175:diagnosis*
Alcoholic severe acute pancreatitis; Chronic pancreatitis; Nasopancreatic drainage; Pancreatic ductitis; Pancreatic stent; Positive pancreatic juice culture