Progress of acute obstructive suppurative pancreatic ductitis in diagnosis and treatment_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHONG Wan , PAN Chao ,  LIU Zijun

Department of General Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, P. R. China;

Corresponding author：

LIU Zijun, Email: liuzijundoctor@sina.com

Keywords：

pancreatic ductitis; pancreatic duct dilatation; pancreatic duct stone; chronic pancreatitis; endoscopic drainage

DOI：

10.7507/1007-9424.202206002

Video：

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Objective To investigate the etiology, pathogenesis, clinical manifestations, diagnosis and treatment of acute obstructive suppurative pancreatic ductitis (AOSPD). Method The literature reports on AOSPD at home and abroad were reviewed and analyzed comprehensively based on clinical experience. Results AOSPD was a rare clinically infectious disease of purulent pancreatic duct. Chronic pancreatitis and ampullary operations were the main pathogenesis factors. The clinical symptoms were non-specific, and the imaging manifestations were pancreatic duct dilatation and pancreatic duct calculi. The clinical diagnosis was mainly determined by epigastrium CT or endoscopic retrograde cholangiopancreatography, which was easy to be misdiagnosed and missed. Conclusion The clinical diagnosis of AOSPD is difficult, early pancreatic duct drainage is the key to the treatment, and attention should be paid to its diagnosis and treatment.

Citation： ZHONG Wan, PAN Chao, LIU Zijun. Progress of acute obstructive suppurative pancreatic ductitis in diagnosis and treatment. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2023, 30(1): 110-114. doi: 10.7507/1007-9424.202206002 Copy

1.	Weinman DS. Acute suppuration of the pancreatic duct. Gastrointest Endosc, 1995, 41(3): 268-270.
2.	Kondo H, Naitoh I, Okumura F, et al. Clinical features of acute obstructive suppurative pancreatic ductitis: A retrospective review of 20 cases. J Gastroenterol Hepatol, 2016, 31(7): 1366-1373.
3.	Shimizuguchi R, Kikuyama M, Kamisawa T, et al. Acute obstructive suppurative pancreatic ductitis in pancreatic malignancies. Endosc Int Open, 2020, 8(12): E1765-E1768. doi: 10.1055/a-1268-7086.
4.	Iwatsuka K, Nakagawara H, Ogawa M, et al. Spontaneous development of acute obstructive suppurative pancreatic ductitis associated with pancreatic carcinoma: A first case report. Intern Med, 2018, 57(9): 1241-1245.
5.	曹俊, 丁希伟, 郑汝桦, 等. 急性梗阻性化脓性胰管炎诊治一例(含视频). 中华消化内镜杂志, 2019, 36(8): 612-613.
6.	Rubinstein E, Mark Z, Haspel J, et al. Antibacterial activity of the pancreatic fluid. Gastroenterology, 1985, 88(4): 927-932.
7.	Parida SK, Pottakkat B, Raja K, et al. Bacteriological profile of pancreatic juice in patients with chronic pancreatitis. Journal of the pancreas, 2014, 15(5): 475-477.
8.	Sugita R, Ito K, Noda Y. Value of pancreatic and biliary flow MR imaging in the evaluation of pancreaticobiliary disorders. Japanese journal of radiology, 2020, 38(6): 507-515.
9.	Bachmann K, Melling N, Groteluschen R, et al. Morphologic factors predict pain relief following pancreatic head resection in chronic pancreatitis description of the chronic pancreatitis pain relief (CPPR) score. Annals of surgery, 2021, 273(4): 800-805.
10.	Lee AA, Baker JR, Wamsteker EJ, et al. Small intestinal bacterial overgrowth is common in chronic pancreatitis and associates with diabetes, chronic pancreatitis severity, low zinc levels, and opiate use. The American journal of gastroenterology, 2019, 114(7): 1163-1171.
11.	Frost F, Weiss FU, Sendler M, et al. The gut microbiome in patients with chronic pancreatitis is characterized by significant dysbiosis and overgrowth by opportunistic pathogens. Clin Transl Gastroenterol, 2020, 11(9): e00232. doi: 10.14309/ctg.0000000000000232.
12.	Twardowska A, Makaro A, Binienda A, et al. Preventing bacterial translocation in patients with leaky gut syndrome: nutrition and pharmacological treatment options. Int J Mol Sci, 2022, 23(6): 3204. doi: 10.3390/ijms23063204.
13.	Wang Z, Zhang PP, Bai Y, et al. A rare case of acute obstructive suppurative pancreatic ductitis associated with ERCP. Rev Esp Enferm Dig, 2019, 111(1): 73. doi: 10.17235/reed.2018.5756/2018.
14.	Ruan HQ, Liao GL, Peng P, et al. Microbial profiles and risk factors of preexisting biliary infection in patients with therapeutic endoscopy. Gastroenterol Res Pract, 2019, 2019: 1527328. doi: 10.1155/2019/1527328.
15.	Tajima Y, Kuroki T, Susumu S, et al. Acute suppuration of the pancreatic duct associated with pancreatic ductal obstruction to pancreas carcinoma. Pancreas, 2006, 33(2): 195-197.
16.	Krüger CM, Adam U, Adam T, et al. Bacterobilia in pancreatic surgery-conclusions for perioperative antibiotic prophylaxis. World J Gastroenterol, 2019, 25(41): 6238-6247.
17.	Shirai Hiroaki, Ito Cocoro, Tsukada Kosuke. pH-taxis drives aerobic bacteria in duodenum to migrate into the pancreas with tumors. Sci Rep, 2022, 12(1): 1783. doi: 10.1038/s41598-022-05554-8.
18.	Nishie H, Okumura F, Fukusada S, et al. A case of intraductal papillary mucinous carcinoma found with acute obstructive suppurative pancreatic ductitis and liver abscess, and associated with a pancreatobiliary fistula. Nihon Shokakibyo Gakkai Zasshi, 2013, 110(7): 1304-1312.
19.	Radlinger B, Ramoser G, Kaser S. Exocrine pancreatic insufficiency in type 1 and type 2 diabetes. Curr Diab Rep, 2020, 20(6): 18. doi: 10.1007/s11892-020-01304-0.
20.	Critchley JA, Carey IM, Harris T, et al. Glycemic control and risk of infections among people with type 1 or type 2 diabetes in a large primary care cohort study. Diabetes Care, 2018, 41(10): 2127-2135.
21.	van Crevel R, van de Vijver S, Moore DAJ. The global diabetes epidemic: what does it mean for infectious diseases in tropical countries? Lancet Diabetes Endocrinol, 2017, 5(6): 457-468.
22.	Akirov A, Diker-Cohen T, Masri-Iraqi H, et al. Outcomes of hyperglycemia in patients with and without diabetes hospitalized for infectious diseases. Diabetes Metab Res Rev, 2018, 34(7): e3027. doi: 10.1002/dmrr.3027.
23.	Lisco G, Giagulli VA, De Pergola G, et al. Hyperglycemia-induced immune system disorders in diabetes mellitus and the concept of hyperglycemic memory of innate immune cells: a perspective. Endocr Metab Immune Disord Drug Targets, 2022, 22(4): 367-370.
24.	Thurlow LR, Stephens AC, Hurley KE, et al. Lack of nutritional immunity in diabetic skin infections promotes Staphylococcus aureus virulence. Sci Adv, 2020, 6(46): eabc5569. doi: 10.1126/sciadv.abc5569.
25.	Fernández-Grajera M, Pacha-Olivenza MA, Gallardo-Moreno AM, et al. Modification of physico-chemical surface properties and growth of Staphylococcus aureus under hyperglycemia and ketoacidosis conditions. Colloids Surf B Biointerfaces, 2022, 209(Pt 1): 112137. doi: 10.1016/j.colsurfb.2021.112137.
26.	Fujimori N, Igarashi H, Ito T. Acute obstructive suppurative pancreatic ductitis. Clin Gastroenterol Hepatol, 2011, 9(8): A28. doi:10.1016/j.cgh.2011.03.012.
27.	Singh VK, Yadav D, Garg PK. Diagnosis and management of chronic pancreatitis: a review, JAMA, 2019, 322(24): 2422-2434.
28.	Meroni M, Longo M, Dongiovanni P. Alcohol or gut microbiota: Who is the guilty? Int J Mol Sci, 2019, 20(18): 4568-4590.
29.	Capurso G, Lahner E. The interaction between smoking, alcohol and the gut microbiome. Best Pract Res Clin Gastroenterol, 2017, 31(5): 579-588.
30.	Yan AW, Fouts DE, Brandl J, et al. Enteric dysbiosis associated with a mouse model of alcoholic liver disease. Hepatology, 2011, 53(1): 96-105.
31.	Kong L, Chen J, Ji X, et al. Alcoholic fatty liver disease inhibited the co-expression of Fmo5 and PPARα to activate the NF-κB signaling pathway, thereby reducing liver injury via inducing gut microbiota disturbance. J Exp Clin Cancer Res, 2021, 40(1): 18. doi:10.1186/s13046-020-01782-w.
32.	Setiawan VW, Pandol SJ, Porcel J, et al. Prospective study of alcohol drinking, smoking, and pancreatitis: The multiethnic cohort. Pancreas, 2016, 45(6): 819-825.
33.	Masamune A, Nabeshima T, Kikuta K, et al. Prospective study of early chronic pancreatitis diagnosed based on the Japanese diagnostic criteria. J Gastroenterol, 2019, 54(10): 928-935.
34.	Wali E, Koo P, Packer CD. Acute obstructive suppurative pancreatic ductitis in an asymptomatic patient. Case Rep Med, 2015, 2015: 919452. doi:10.1155/2015/919452.
35.	Deeb LS, Bajaj J, Bhargava S, et al. Acute suppuration of the pancreatic duct in a patient with tropical pancreatitis. Case Rep Gastroenterol, 2008, 2(1): 27-32.
36.	Fujinaga T, Nishida T, Miyazaki M, et al. Acute suppurative pancreatic ductitis associated with pancreatic duct obstruction. Endoscopy, 2013, 45 Suppl 2 UCTN: E135. doi:10.1055/s-0032-1326450.
37.	柴悦, 王震宇. 胰管结石嵌顿致急性梗阻性化脓性胰管炎一例. 中华消化内镜杂志, 2019, 36(6): 439-441.
38.	福地聡士, 木下慶亮, 齋藤衆子, 等. 膵癌に発症した化膿性膵管炎の1例. 日本消化器内視鏡学会雑誌, 2015, 57(3): 247-253.
39.	Shimizuguchi R, Kikuyama M, Kamisawa T, et al. Acute obstructive suppurative pancreatic ductitis (AOSPD) in pancreatic cancer treated by nasopancreatic drainage. Clin J Gastroenterol, 2018, 11(4): 315-319.
40.	Yuji O, Masataka K, Takafumi K, et al. Six cases of acute obstructive suppurative pancreatic ductitis. J Jpn Pancreas Soc, 2012, 27(6): 755-761.
41.	Gedam BS, Sadriwala QS, Bansod PY. Chronic pancreatitis with acute obstructive suppurative pancreatic ductitis: a rare case report. J Surg Case Rep, 2017, 2017(2): rjx034. doi:10.1093/jscr/rjx034.
42.	Will U, Reichel A, Fueldner F, et al. Endoscopic ultrasonography-guided drainage for patients with symptomatic obstruction and enlargement of the pancreatic duct. World J Gastroenterol, 2015, 21(46): 13140-13151.
43.	Imoto A, Ogura T, Higuchi K. Endoscopic Ultrasound-Guided Pancreatic Duct Drainage: Techniques and Literature Review of Transmural Stenting. Clin Endosc, 2020, 53(5): 525-534.
44.	van der Merwe SW, van Wanrooij RLJ, Bronswijk M, et al. Therapeutic endoscopic ultrasound: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy, 2022, 54(2): 185-205.
45.	Isono Y, Matsusaki S, Tanaka H, et al. Acute obstructive suppurative pancreatic ductitis after endoscopic retrograde cholangiopancreatography in a patient with carcinoma of the pancreatic head: a case report. Nihon Shokakibyo Gakkai Zasshi, 2016, 113(2): 289-295.

1. Weinman DS. Acute suppuration of the pancreatic duct. Gastrointest Endosc, 1995, 41(3): 268-270.
2. Kondo H, Naitoh I, Okumura F, et al. Clinical features of acute obstructive suppurative pancreatic ductitis: A retrospective review of 20 cases. J Gastroenterol Hepatol, 2016, 31(7): 1366-1373.
3. Shimizuguchi R, Kikuyama M, Kamisawa T, et al. Acute obstructive suppurative pancreatic ductitis in pancreatic malignancies. Endosc Int Open, 2020, 8(12): E1765-E1768. doi: 10.1055/a-1268-7086.
4. Iwatsuka K, Nakagawara H, Ogawa M, et al. Spontaneous development of acute obstructive suppurative pancreatic ductitis associated with pancreatic carcinoma: A first case report. Intern Med, 2018, 57(9): 1241-1245.
5. 曹俊, 丁希伟, 郑汝桦, 等. 急性梗阻性化脓性胰管炎诊治一例(含视频). 中华消化内镜杂志, 2019, 36(8): 612-613.
6. Rubinstein E, Mark Z, Haspel J, et al. Antibacterial activity of the pancreatic fluid. Gastroenterology, 1985, 88(4): 927-932.
7. Parida SK, Pottakkat B, Raja K, et al. Bacteriological profile of pancreatic juice in patients with chronic pancreatitis. Journal of the pancreas, 2014, 15(5): 475-477.
8. Sugita R, Ito K, Noda Y. Value of pancreatic and biliary flow MR imaging in the evaluation of pancreaticobiliary disorders. Japanese journal of radiology, 2020, 38(6): 507-515.
9. Bachmann K, Melling N, Groteluschen R, et al. Morphologic factors predict pain relief following pancreatic head resection in chronic pancreatitis description of the chronic pancreatitis pain relief (CPPR) score. Annals of surgery, 2021, 273(4): 800-805.
10. Lee AA, Baker JR, Wamsteker EJ, et al. Small intestinal bacterial overgrowth is common in chronic pancreatitis and associates with diabetes, chronic pancreatitis severity, low zinc levels, and opiate use. The American journal of gastroenterology, 2019, 114(7): 1163-1171.
11. Frost F, Weiss FU, Sendler M, et al. The gut microbiome in patients with chronic pancreatitis is characterized by significant dysbiosis and overgrowth by opportunistic pathogens. Clin Transl Gastroenterol, 2020, 11(9): e00232. doi: 10.14309/ctg.0000000000000232.
12. Twardowska A, Makaro A, Binienda A, et al. Preventing bacterial translocation in patients with leaky gut syndrome: nutrition and pharmacological treatment options. Int J Mol Sci, 2022, 23(6): 3204. doi: 10.3390/ijms23063204.
13. Wang Z, Zhang PP, Bai Y, et al. A rare case of acute obstructive suppurative pancreatic ductitis associated with ERCP. Rev Esp Enferm Dig, 2019, 111(1): 73. doi: 10.17235/reed.2018.5756/2018.
14. Ruan HQ, Liao GL, Peng P, et al. Microbial profiles and risk factors of preexisting biliary infection in patients with therapeutic endoscopy. Gastroenterol Res Pract, 2019, 2019: 1527328. doi: 10.1155/2019/1527328.
15. Tajima Y, Kuroki T, Susumu S, et al. Acute suppuration of the pancreatic duct associated with pancreatic ductal obstruction to pancreas carcinoma. Pancreas, 2006, 33(2): 195-197.
16. Krüger CM, Adam U, Adam T, et al. Bacterobilia in pancreatic surgery-conclusions for perioperative antibiotic prophylaxis. World J Gastroenterol, 2019, 25(41): 6238-6247.
17. Shirai Hiroaki, Ito Cocoro, Tsukada Kosuke. pH-taxis drives aerobic bacteria in duodenum to migrate into the pancreas with tumors. Sci Rep, 2022, 12(1): 1783. doi: 10.1038/s41598-022-05554-8.
18. Nishie H, Okumura F, Fukusada S, et al. A case of intraductal papillary mucinous carcinoma found with acute obstructive suppurative pancreatic ductitis and liver abscess, and associated with a pancreatobiliary fistula. Nihon Shokakibyo Gakkai Zasshi, 2013, 110(7): 1304-1312.
19. Radlinger B, Ramoser G, Kaser S. Exocrine pancreatic insufficiency in type 1 and type 2 diabetes. Curr Diab Rep, 2020, 20(6): 18. doi: 10.1007/s11892-020-01304-0.
20. Critchley JA, Carey IM, Harris T, et al. Glycemic control and risk of infections among people with type 1 or type 2 diabetes in a large primary care cohort study. Diabetes Care, 2018, 41(10): 2127-2135.
21. van Crevel R, van de Vijver S, Moore DAJ. The global diabetes epidemic: what does it mean for infectious diseases in tropical countries? Lancet Diabetes Endocrinol, 2017, 5(6): 457-468.
22. Akirov A, Diker-Cohen T, Masri-Iraqi H, et al. Outcomes of hyperglycemia in patients with and without diabetes hospitalized for infectious diseases. Diabetes Metab Res Rev, 2018, 34(7): e3027. doi: 10.1002/dmrr.3027.
23. Lisco G, Giagulli VA, De Pergola G, et al. Hyperglycemia-induced immune system disorders in diabetes mellitus and the concept of hyperglycemic memory of innate immune cells: a perspective. Endocr Metab Immune Disord Drug Targets, 2022, 22(4): 367-370.
24. Thurlow LR, Stephens AC, Hurley KE, et al. Lack of nutritional immunity in diabetic skin infections promotes Staphylococcus aureus virulence. Sci Adv, 2020, 6(46): eabc5569. doi: 10.1126/sciadv.abc5569.
25. Fernández-Grajera M, Pacha-Olivenza MA, Gallardo-Moreno AM, et al. Modification of physico-chemical surface properties and growth of Staphylococcus aureus under hyperglycemia and ketoacidosis conditions. Colloids Surf B Biointerfaces, 2022, 209(Pt 1): 112137. doi: 10.1016/j.colsurfb.2021.112137.
26. Fujimori N, Igarashi H, Ito T. Acute obstructive suppurative pancreatic ductitis. Clin Gastroenterol Hepatol, 2011, 9(8): A28. doi:10.1016/j.cgh.2011.03.012.
27. Singh VK, Yadav D, Garg PK. Diagnosis and management of chronic pancreatitis: a review, JAMA, 2019, 322(24): 2422-2434.
28. Meroni M, Longo M, Dongiovanni P. Alcohol or gut microbiota: Who is the guilty? Int J Mol Sci, 2019, 20(18): 4568-4590.
29. Capurso G, Lahner E. The interaction between smoking, alcohol and the gut microbiome. Best Pract Res Clin Gastroenterol, 2017, 31(5): 579-588.
30. Yan AW, Fouts DE, Brandl J, et al. Enteric dysbiosis associated with a mouse model of alcoholic liver disease. Hepatology, 2011, 53(1): 96-105.
31. Kong L, Chen J, Ji X, et al. Alcoholic fatty liver disease inhibited the co-expression of Fmo5 and PPARα to activate the NF-κB signaling pathway, thereby reducing liver injury via inducing gut microbiota disturbance. J Exp Clin Cancer Res, 2021, 40(1): 18. doi:10.1186/s13046-020-01782-w.
32. Setiawan VW, Pandol SJ, Porcel J, et al. Prospective study of alcohol drinking, smoking, and pancreatitis: The multiethnic cohort. Pancreas, 2016, 45(6): 819-825.
33. Masamune A, Nabeshima T, Kikuta K, et al. Prospective study of early chronic pancreatitis diagnosed based on the Japanese diagnostic criteria. J Gastroenterol, 2019, 54(10): 928-935.
34. Wali E, Koo P, Packer CD. Acute obstructive suppurative pancreatic ductitis in an asymptomatic patient. Case Rep Med, 2015, 2015: 919452. doi:10.1155/2015/919452.
35. Deeb LS, Bajaj J, Bhargava S, et al. Acute suppuration of the pancreatic duct in a patient with tropical pancreatitis. Case Rep Gastroenterol, 2008, 2(1): 27-32.
36. Fujinaga T, Nishida T, Miyazaki M, et al. Acute suppurative pancreatic ductitis associated with pancreatic duct obstruction. Endoscopy, 2013, 45 Suppl 2 UCTN: E135. doi:10.1055/s-0032-1326450.
37. 柴悦, 王震宇. 胰管结石嵌顿致急性梗阻性化脓性胰管炎一例. 中华消化内镜杂志, 2019, 36(6): 439-441.
38. 福地聡士, 木下慶亮, 齋藤衆子, 等. 膵癌に発症した化膿性膵管炎の1例. 日本消化器内視鏡学会雑誌, 2015, 57(3): 247-253.
39. Shimizuguchi R, Kikuyama M, Kamisawa T, et al. Acute obstructive suppurative pancreatic ductitis (AOSPD) in pancreatic cancer treated by nasopancreatic drainage. Clin J Gastroenterol, 2018, 11(4): 315-319.
40. Yuji O, Masataka K, Takafumi K, et al. Six cases of acute obstructive suppurative pancreatic ductitis. J Jpn Pancreas Soc, 2012, 27(6): 755-761.
41. Gedam BS, Sadriwala QS, Bansod PY. Chronic pancreatitis with acute obstructive suppurative pancreatic ductitis: a rare case report. J Surg Case Rep, 2017, 2017(2): rjx034. doi:10.1093/jscr/rjx034.
42. Will U, Reichel A, Fueldner F, et al. Endoscopic ultrasonography-guided drainage for patients with symptomatic obstruction and enlargement of the pancreatic duct. World J Gastroenterol, 2015, 21(46): 13140-13151.
43. Imoto A, Ogura T, Higuchi K. Endoscopic Ultrasound-Guided Pancreatic Duct Drainage: Techniques and Literature Review of Transmural Stenting. Clin Endosc, 2020, 53(5): 525-534.
44. van der Merwe SW, van Wanrooij RLJ, Bronswijk M, et al. Therapeutic endoscopic ultrasound: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy, 2022, 54(2): 185-205.
45. Isono Y, Matsusaki S, Tanaka H, et al. Acute obstructive suppurative pancreatic ductitis after endoscopic retrograde cholangiopancreatography in a patient with carcinoma of the pancreatic head: a case report. Nihon Shokakibyo Gakkai Zasshi, 2016, 113(2): 289-295.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Progress of acute obstructive suppurative pancreatic ductitis in diagnosis and treatment

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