2009 Volume 24 Issue 4 Pages 513-520
A 59-year-old man was admitted to our hospital because of epigastric pain and elevated amylase levels. Abdominal CT showed a diffuse, enlarged pancreas without dilatation of the pancreatic duct. Magnetic resonance cholangiopancreatography showed a stricture of the lower common bile duct. Endoscopic retrograde cholangiopancreatography showed a diffuse stricture of the intrahepatic bile duct, a smooth stricture of the lower common bile duct, and irregular narrowing of the pancreatic duct in the pancreatic head and body. Based on these findings and elevated IgG4 levels, he was diagnosed as autoimmune pancreatitis with bile duct stricture. The bile duct stricture improved during hospitalization. Moreover, after administration of prednisolone (30mg daily), his symptoms resolved. After discharge from the hospital, the prednisolone dose was tapered off but he was re-admitted because of acute cholangitis. Endoscopic retrograde cholangiopancreatography showed a severe stricture of the upper common bile duct differing from the findings in the first attack. Endoscopic nasobiliary drainage and prednisolone (30mg daily), however, improved his symptoms.
