Suizo
Online ISSN : 1881-2805
Print ISSN : 0913-0071
ISSN-L : 0913-0071
Volume 34, Issue 6
Displaying 1-5 of 5 articles from this issue
Guideline
Special Edition
  • Atsushi MASAMUNE, Atsushi IRISAWA, Kazuhiro KIKUTA, Tsukasa IKEURA, Sh ...
    2019 Volume 34 Issue 6 Pages 282-292
    Published: December 25, 2019
    Released on J-STAGE: January 23, 2020
    JOURNAL FREE ACCESS

    Ten years have passed since the current clinical diagnostic criteria for chronic pancreatitis (CP) were proposed. These criteria, which incorporated the concept of early CP for the first time in the world, required revision because of issues raised by subsequent studies and changes in the management of CP. We, the Japan Pancreas Society, hereby propose the "Diagnostic criteria for chronic pancreatitis 2019". The most characteristic feature of the new diagnostic criteria is the incorporation of a mechanistic definition of CP as a disease concept, and items for the diagnosis of early CP were revised from the viewpoint of risk factors for CP. Mutations in the pancreatitis-associated genes and a past history of acute pancreatitis were adapted, and the number of clinical signs required for diagnosis was changed from 2 to 3 to increase the diagnostic specificity. The daily alcohol intake needed to define excessive alcohol use was decreased from 80g (pure ethanol) to 60g. Furthermore, magnetic resonance cholangiopancreatography findings were incorporated, and imaging findings on endoscopic ultrasonography were simplified to establish the diagnosis of early CP. We expect that these new diagnostic criteria will increase the quality of management of patients with CP, eventually leading to an improved prognosis.

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Case Reports
  • Shinji MIYAJIMA, Shoutai TAKEDA, Muneji YASUDA, Tomoko HOSHI, Susumu H ...
    2019 Volume 34 Issue 6 Pages 293-301
    Published: December 25, 2019
    Released on J-STAGE: January 23, 2020
    JOURNAL FREE ACCESS

    A 70-year-old man presented with epigastric pain and was diagnosed with acute pancreatitis with diffuse pancreatic swelling and pseudocysts on abdominal CT scan and MRI. Despite non-operative management, he developed diarrhea and abdominal discomfort and was confirmed to have massive ascites and thromboses in the aorta and portal vein. A pancreatic fistula was diagnosed on the basis of high a amylase level in the ascitic fluid and ERCP findings of irregular narrowing of the main pancreatic duct with direct leakage of contrast from the pancreatic tail cyst into the abdominal cavity. There was no tumor in the EUS-FNA specimen. He was diagnosed with autoimmune pancreatitis based on the EUS-FNA and ERCP findings and a high level of serum IgG4. After initiating steroid therapy and placement of a pancreatic stent, swelling of the pancreas and ascites were reduced as well as normalization of serum IgG4 levels The steroid dose was tapered, and four months later, the pancreatic stent was removed with resolution of the pancreatic fistula and confirmation of regression of the pancreatic cyst. This is a rare case of autoimmune pancreatitis with a pancreatic fistula secondary to pancreatic cyst rupture.

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  • Naoto KOIKE, Tadashi SHIRAISHI, Masayoshi SAITO, Yuji OHSHIMA, Toshiak ...
    2019 Volume 34 Issue 6 Pages 302-311
    Published: December 25, 2019
    Released on J-STAGE: January 23, 2020
    JOURNAL FREE ACCESS

    A 71-year-old female was found to have a 14 mm hypo-echoic tumor in the head of the pancreas head on screening abdominal ultrasonography. Abdominal contrast CT scan and MRI did not show the lesion. However, EUS also revealed two more tumors, 13.4 and 17.4 mm in the tail of the pancreas. Endoscopic ultrasonography-guided fine needle aspiration was performed for the lesions in the pancreatic head and tail with a suspected diagnosis of pancreatic neuroendocrine tumor (pNET). Enucleation of the pancreatic head lesion and distal pancreatectomy with lymph node dissection were performed. Histopathological examination of the surgical specimen showed a pNET in the head of the pancreas, and the pancreatic tail tumors were IgG4 related autoimmune pancreatitis. In addition, two small pNET lesions, found on histopathological examination were found in the pancreatic tail. The postoperative course was unremarkable and the patient is alive without recurrence more than 4 years postoperatively.

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  • Toyotaka KASAI, Koichi KAWABE, Hiroyuki ETO, Seiji MURAMATSU, Moriyasu ...
    2019 Volume 34 Issue 6 Pages 312-316
    Published: December 25, 2019
    Released on J-STAGE: January 23, 2020
    JOURNAL FREE ACCESS

    A 60-year-old male had eight episodes of acute pancreatitis and was hospitalized seven times over 17-months. Although various studies were performed, the cause of acute pancreatitis could not be determined. Treatment with oral bromhexine hydrochloride was started with the expectation that it would prevent relapse of the pancreatitis and he has not had a relapse for 42 months. The administration of bromhexine hydrochloride may be a viable treatment option for patients with relapsing pancreatitis.

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