Acute Disease ; Aged ; Amylases ; blood ; Humans ; Lipase ; blood ; Magnetic Resonance Imaging ; Male ; Pancreatitis ; complications ; diagnosis ; diagnostic imaging ; Pancreatitis, Chronic ; complications ; diagnosis ; Panniculitis ; diagnosis ; diagnostic imaging ; etiology ; pathology

Portal vein thrombosis is an uncommon but an important cause of portal hypertension. The most common etiological factors of portal vein thrombosis are liver cirrhosis and malignancy. Albeit rare, portal vein thrombosis can also occur in the presence of local infection and inflammation such as pancreatitis or cholecystitis. A 52-year-old male was admitted because of general weakness and poor oral intake. He had an operation for colon cancer 18 months ago. However, colonic stent had to be inserted afterwards because stricture developed at anastomosis site. Computed tomography taken at admission revealed portal vein thrombosis and inflammation at colonic stent insertion site. Blood culture was positive for Escherichia coli. After antibiotic therapy, portal vein thrombosis resolved. Herein, we report a case of portal vein thrombosis with sepsis caused by inflammation at colonic stent insertion site which was successfully treated with antibiotics.
Anti-Bacterial Agents/therapeutic use ; Cholecystitis/etiology ; Colonic Neoplasms/pathology/therapy ; Escherichia coli/isolation & purification ; Escherichia coli Infections/drug therapy/etiology ; Humans ; Inflammation/*etiology ; Liver/diagnostic imaging ; Male ; Middle Aged ; Pancreatitis/etiology ; Portal Vein ; Sepsis/*diagnosis/drug therapy/microbiology ; Sigmoidoscopy ; Stents/*adverse effects ; Tomography, X-Ray Computed ; Venous Thrombosis/complications/*diagnosis

A 63-year-old man presented with painless jaundice, loss of appetite and significant weight loss. Cross-sectional imaging showed a diffusely enlarged pancreas, with no significant fat stranding and a hypodense rim on computed tomography, which appeared hypointense on T2-weighted magnetic resonance imaging. There was a narrowed pancreatic duct and features of common bile duct narrowing in the region of the pancreatic head. However, there was no obvious mass seen in the pancreatic head region. These features were classical of autoimmune pancreatitis with diffuse involvement of the gland. Laboratory investigation showed abnormal liver function and the classical sign of raised immunoglobulin G class 4 antibodies. The patient showed dramatic response to high-dose steroids, with resolution of both the laboratory and imaging abnormalities within one month. We discuss the classical imaging features of Type 1 autoimmune pancreatitis, an uncommon condition that needs to be differentiated from pancreatic malignancy.
Autoimmune Diseases ; diagnostic imaging ; pathology ; Diagnostic Imaging ; Humans ; Jaundice ; complications ; diagnosis ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Pancreas ; diagnostic imaging ; pathology ; Pancreatitis ; diagnostic imaging ; pathology ; Tomography, X-Ray Computed

IgG4-related systemic diseases are characterized by a diffuse or mass forming inflammatory reaction rich in lymphocytes and IgG4-positive plasma cells (lymphoplasmacytic infiltration), fibrosclerosis of variable organs and obliterative phlebitis. They usually involve various organs including the pancreas, bile duct, gallbladder, salivary gland, retroperitoneum, kidney, lung, and prostate. However, most of them are accompanied by autoimmune pancreatitis, and good response to steroid treatment is one of the hallmarks of this disease. We report a case of an 67-year-old man with IgG4 associated sclerosing cholangitis, who was diagnosed by endoscopic retrograde cholangiopancreatography and successfully treated with steroid therapy.
Aged ; Anti-Inflammatory Agents/therapeutic use ; Autoimmune Diseases/complications/diagnosis ; Bile Ducts, Intrahepatic/pathology/ultrasonography ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis, Sclerosing/complications/*diagnosis/drug therapy ; Common Bile Duct/pathology/ultrasonography ; Humans ; Immunoglobulin G/*blood ; Immunohistochemistry ; Male ; Pancreatitis/complications/diagnosis ; Prednisolone/therapeutic use ; Tomography, X-Ray Computed

Xanthogranulomatous inflammation (XGI) is a rare, idiopathic process in which lipid-laden histiocytes are deposited at various locations in the body. Although XGI has been reported to occur in various organs such as the gallbladder, kidney, bone, stomach, colon, appendix, lymph nodes, urachus, and urinary bladder and in soft tissues, xanthogranulomatous pancreatitis (XGP) is extremely rare. Herein, we report a case of XGP occurring in a 70-yr-old woman, who presented with abdominal pain for several months. On physical examination, mild epigastric tenderness was noted. Abdomen CT scan revealed a low attenuated mass in uncinate process of pancreas, suggesting malignant lesion. Whipple's operation was performed and the final pathologic diagnosis was XGP. The patient's post-operative course was uneventful, and no recurrence was found within 7 months of the operation. When a pancreatic mass does not show clinico-radiological features typical of common pancreatic neoplasms, XGP should be considered for a differential diagnosis.
Aged ; Diagnosis, Differential ; Duodenum/surgery ; Female ; Granuloma/complications/*diagnosis/pathology ; Humans ; Pancreas/surgery ; Pancreatic Neoplasms/pathology ; Pancreatitis/complications/*diagnosis/pathology ; Positron-Emission Tomography ; Tomography, X-Ray Computed ; Xanthomatosis/complications/*diagnosis/pathology

Xanthogranulomatous lesion is a rare condition in which lipid-laden histiocytes are deposited at various locations in the body. Xanthogranulomatous pancreatitis (XGP) associated with an intraductal papillary mucinous tumor (IPMT) is extremely rare. In this study, we described a case of XGP associated with IPMT and include a review of the literature. A pancreatic cystic mass was detected in a 72-yr-old woman by abdominal computed tomography. Pylorus-preserving pancreaticoduodenectomy was performed and diagnosis of XGP combined with intraductal papillary mucinous carcinoma in situ was made. After 13 months of follow-up, the patient is in good health without any evidence of tumor recurrence. Although XGP associated with IPMT is rare, we suggest that such cases should be brought to the attention of clinical investigators, as it may produce clinical features that mimic pancreatic cancer.
Adenocarcinoma, Mucinous/*diagnosis/pathology/surgery ; Aged ; Carcinoma in Situ/*diagnosis/pathology/surgery ; Carcinoma, Pancreatic Ductal/*diagnosis/pathology/surgery ; Carcinoma, Papillary/*diagnosis/pathology/surgery ; Diagnosis, Differential ; Female ; Granuloma/complications/*diagnosis ; Humans ; Magnetic Resonance Imaging ; Pancreatic Neoplasms/*diagnosis/pathology/surgery ; Pancreaticoduodenectomy ; Pancreatitis/complications/*diagnosis ; Tomography, X-Ray Computed ; Xanthomatosis/complications/*diagnosis

Intramural duodenal hematoma is an uncommon condition, which usually develops after blunt abdominal trauma. It is also reported as a complication of anticoagulant therapy, blood dyscrasia, pancreatic disease, and diagnostic and therapeutic endoscopy. The typical clinical pictures of intramural duodenal hematoma consist of upper abdominal pain, vomiting, fever, and hematochezia, and it is rarely accompanied by intestinal obstruction, peritonitis, and pancreatitis as its complication. We report a case of intramural duodenal hematoma extended to peritoneal cavity, and accompanied by acute pancreatitis following therapeutic endoscopy for duodenal ulcer bleeding in a 32-year-old man who was on maintenance of anti-coagulation therapy after valvular heart surgery.
Acute Disease ; Adult ; Diagnosis, Differential ; Duodenal Diseases/*diagnosis/pathology/surgery ; Duodenal Ulcer/*complications ; Hematoma/*diagnosis/pathology/surgery ; *Hemostasis, Endoscopic ; Humans ; Male ; Pancreatitis/complications/*diagnosis ; Peptic Ulcer Hemorrhage/*therapy ; Postoperative Complications ; Tomography, X-Ray Computed

No abstract available.
Child, Preschool ; Cholestasis/diagnosis/etiology ; Drainage ; Female ; Fibrosis ; Humans ; Jaundice, Obstructive/*diagnosis/etiology ; Pancreatitis/complications/*diagnosis/pathology ; Tomography, X-Ray Computed

OBJECTIVETo compare the findings of pancreaticobiliary duct dilation due to pancreatic carcinoma and chronic pancreatitis by magnetic resonance cholangiopancreatography (MRCP).

METHODSMRCP findings in 28 cases of pancreatic carcinoma and 42 cases of chronic pancreatitis were retrospectively analyzed. Both plain MR and MRCP examinations were performed in all the cases after oral Gd-DTPA dilution.

RESULTSMRCP in the patients with pancreatic carcinoma displayed dilated pancreatic duct with smooth and regular caliber (n=16, 72.7%), dilated common biliary duct with abrupt rupture in most cases (n=18, 90%) and intra- and extra-hepatic cholangiectasis (n=12, 42.8%), and the double-duct sign (n=19, 86.5%). In the patients with chronic pancreatitis, MRCP identified irregular dilation of the pancreatic duct across the whole segment of the lesion (n= 20, 60.6%), taper of the dilated common bile duct (n=8, 80%), stones within the pancreatic duct (n=5, 11.9%), and pancreatic pseudocsyt within the pancreatic duct (n=21, 50%).

CONCLUSIONCholangiopancreatographic findings of pancreaticobiliary duct dilation are of great value in distinguishing pancreatic carcinoma from chronic pancreatitis.

Adult ; Aged ; Aged, 80 and over ; Cholangiopancreatography, Magnetic Resonance ; methods ; Chronic Disease ; Common Bile Duct ; pathology ; Diagnosis, Differential ; Dilatation, Pathologic ; etiology ; Female ; Humans ; Male ; Middle Aged ; Pancreatic Ducts ; pathology ; Pancreatic Neoplasms ; complications ; diagnosis ; Pancreatitis ; complications ; diagnosis ; Reproducibility of Results ; Sensitivity and Specificity

BACKGROUND/AIMS: Pseudoaneurysm is a life-threatening complication of chronic or acute pancreatitis. This study was undertaken to evaluate the clinical features of pseudoaneurysm complicating pancreatitis. METHODS: We reviewed the medical records of 7 patients diagnosed as pseudoaneurysms with chronic pancreatitis in Korea University Guro and Anam Hospital from January 1995 to March 2006 and analyzed their demographics, clinical courses and outcomes. RESULTS: All patients were men and mean age was 54.6 years (range, 43-67 years). All the cases occurred in the setting of chronic alcoholic pancreatitis complicated by pseudocyst. Abdominal pain was the unique initial clinical symptom in 5 cases, hematemesis in 1 case, and simultaneous abdominal pain with hematemesis in 1 case. Bleeding into pseudocyst developed in 5 cases, flowing into duodenum through pancreatic duct in 1 case and rupture into the descending colon in 1 case. Mean duration between onset of symptom and diagnosis of pseudoaneurysm was 7.8 days (range, 1-23 days). Six cases were diagnosed by abdominal computed tomography disclosing characteristic finding of focal high density area in the pseudocyst. Pulsed doppler abdominal sonography was performed before computed tomography in 3 cases and results were negative in 2 cases. Transcatheter arterial embolizations were initially performed in 6 cases, and there was no recurrent bleeding except one case of splenic infarction. Distal pancreatectomy was initially performed in 1 case. CONCLUSIONS: Pseudoaneurysms complicating chronic pancreatitis shows various clinical features. Transcatheter arterial embolization can be recommended as a primary therapeutic modality.
Adult ; Aged ; Aneurysm, False/*diagnosis/etiology/ultrasonography ; Arteries/injuries ; Demography ; Embolization, Therapeutic ; Hemorrhage/etiology/surgery ; Humans ; Korea ; Male ; Middle Aged ; Pancreatic Pseudocyst/etiology/surgery ; Pancreatitis, Alcoholic/*complications/pathology ; Retrospective Studies ; Tomography, X-Ray Computed