Six cases of acute obstructive suppurative pancreatic ductitis

Abstract

We experienced 6 cases of chronic pancreatitis with calculus exhibiting pus-containing pancreatic juice on endoscopic retrograde cholangiopancreatography (ERCP), along with hyperpyrexia, abdominal pain, and systemic inflammatory response. We defined this disease state as acute obstructive suppurative pancreatic ductitis (AOSPD) based on the similarity to acute obstructive suppurative cholangitis (AOSC). Five of 6 patients with positive pancreatic juice culture for indigenous intestinal bacteria were successfully treated with endoscopic naso-pancreatic drainage (ENPD). The other one case underwent surgery because of difficulty for endoscopic treatment. Thus, in cases of acute exacerbation of chronic pancreatitis with pancreatic calculus and hyperpyrexia, the possibility of AOSPD and the indication of ENPD should be considered.