title: Clinical features of acute obstructive suppurative pancreatic ductitis: A retrospective review of 20 cases.
abstract: OBJECTIVE
  The clinical features of acute obstructive suppurative pancreatic ductitis (AOSPD) have not been elucidated. We aimed to clarify the clinical features of AOSPD.
  
  
  METHODS
  We retrospectively reviewed the clinical features of 20 patients with AOSPD at two tertiary referral centers between 1993 and 2012. We compared 17 AOSPD patients with chronic pancreatitis (CP) and 42 patients with acute-on-CP in terms of clinical characteristics, presentation, and laboratory and imaging findings.
  
  
  RESULTS
  The etiology of AOSPD involved CP in 17 (85%) patients, pancreatic ductal adenocarcinoma in 2 (10%), and intraductal papillary mucinous neoplasm in 1 (5%). Endoscopic pancreatic drainage was effective in 19 (95%) patients. Body temperature was significantly higher in AOSPD with CP than acute-on-CP patients (median: 38.2 vs 36.9 °C; P < 0.001). Serum amylase levels at onset were significantly lower (median: 133 vs 364.5 U/L; P = 0.009), and C-reactive protein was significantly higher (median: 9.42 vs 1.06 mg/dL; P < 0.001) in AOSPD with CP patients. Enlargement of the pancreatic parenchyma (18 vs 93%; P < 0.001) and stranding of the surrounding fat (12 vs 93%; P < 0.001) on computed tomography were observed less frequently in patients with AOSPD with CP patients. The diameter of the main pancreatic duct was significantly greater in AOSPD with CP than acute-on-CP patients (median: 7 vs 5 mm; P = 0.006).
  
  
  CONCLUSIONS
  The major etiology of AOSPD involved CP, and endoscopic pancreatic drainage was effective. The clinical features differ between AOSPD with CP and acute-on-CP.
authors: Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
authors: Hiromu
authors: H
authors: Kondo
authors: Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
authors: Itaru
authors: I
authors: Naitoh
authors: Department of Gastroenterology, Gifu Prefectural Tajimi Hospital, Tajimi, Japan.
authors: Fumihiro
authors: F
authors: Okumura
authors: Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
authors: Takahiro
authors: T
authors: Nakazawa
authors: Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
authors: Kazuki
authors: K
authors: Hayashi
authors: Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
authors: Katsuyuki
authors: K
authors: Miyabe
authors: Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
authors: Shuya
authors: S
authors: Shimizu
authors: Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
authors: Yuji
authors: Y
authors: Nishi
authors: Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
authors: Michihiro
authors: M
authors: Yoshida
authors: Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
authors: Shuichiro
authors: S
authors: Umemura
authors: Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
authors: Yasuki
authors: Y
authors: Hori
authors: Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
authors: Akihisa
authors: A
authors: Kato
authors: Department of Community-based Medical Education, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
authors: Hirotaka
authors: H
authors: Ohara
authors: Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
authors: Takashi
authors: T
authors: Joh
mesh_terms: D000208:Acute Disease; D000230:Adenocarcinoma / Q000150:complications; D002288:Adenocarcinoma, Mucinous / Q000150:complications; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003251:Constriction, Pathologic; D004322:Drainage; D016145:Endoscopy, Digestive System; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010183:Pancreatic Ducts / Q000473:pathology; D010190:Pancreatic Neoplasms / Q000150:complications; D050500:Pancreatitis, Chronic / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology / Q000601:surgery; D012189:Retrospective Studies; D013492:Suppuration
keywords: acute obstructive suppurative pancreatic ductitis; chronic pancreatitis; endoscopic pancreatic drainage