A 57-year-old man presented with a 2-wk history of painless jaundice and weight loss.He had a large illdefined enhancing mass-like lesion in the uncinate process of the pancreas with stricture of the distal common bil...A 57-year-old man presented with a 2-wk history of painless jaundice and weight loss.He had a large illdefined enhancing mass-like lesion in the uncinate process of the pancreas with stricture of the distal common bile duct.Aspiration cytology of the pancreatic mass demonstrated inflammatory cells without evidence of malignancy.Total serum immunoglobulin G level was slightly elevated,but IgG4 level was normal.After the 2-wk 40 mg prednisolone trial,the patient's symptoms and bilirubin level improved significantly.A follow-up computed tomography(CT) scan showed a dramatic resolution of the pancreatic lesion.A low dose steroid was continued.After six months he self-discontinued prednisolone for 3 wk,and was presented with jaundice again.A CT scan showed newly developed intrahepatic biliary dilatation and marked concentric wall thickening of the common hepatic duct and the proximal common bile duct without pancreatic aggravation.The patient' s IgG4 level was elevated to 2.51 g/L.Prednisolone was started again,after which his serum bilirubin level became normal and the thickening of the bile duct was resolved.This case suggests that autoimmune pancreatitis can progress to other organs that are not involved at the initial diagnosis,even with sustained pancreatic remission.展开更多
Bezoars are concretions of indigestible materials in the gastrointestinal tract. It generally develops in patients with previous gastric surgery or patients with delayed gastric emptying. Cases of periampullary duoden...Bezoars are concretions of indigestible materials in the gastrointestinal tract. It generally develops in patients with previous gastric surgery or patients with delayed gastric emptying. Cases of periampullary duodenal divericular bezoar are rare. Clinical manifestations by a bezoar vary from no symptom to acute abdominal syndrome depending on the location of the bezoar. Biliary obstruction or acute pancreatitis caused by a bezoar has been rarely reported. Small bowel obstruction by a bezoar is also rare, but it is a complication that requires surgery. This is a case of acute pancreatitis and subsequent duodenal obstruction caused by a large duodenal bezoar migrating from a periampullary diverticulum to the duodenal lumen, which mimicked pancreatic abscess or microperforation on abdominal computerized tomography. The patient underwent surgical removal of the bezoar and recovered completely.展开更多
文摘A 57-year-old man presented with a 2-wk history of painless jaundice and weight loss.He had a large illdefined enhancing mass-like lesion in the uncinate process of the pancreas with stricture of the distal common bile duct.Aspiration cytology of the pancreatic mass demonstrated inflammatory cells without evidence of malignancy.Total serum immunoglobulin G level was slightly elevated,but IgG4 level was normal.After the 2-wk 40 mg prednisolone trial,the patient's symptoms and bilirubin level improved significantly.A follow-up computed tomography(CT) scan showed a dramatic resolution of the pancreatic lesion.A low dose steroid was continued.After six months he self-discontinued prednisolone for 3 wk,and was presented with jaundice again.A CT scan showed newly developed intrahepatic biliary dilatation and marked concentric wall thickening of the common hepatic duct and the proximal common bile duct without pancreatic aggravation.The patient' s IgG4 level was elevated to 2.51 g/L.Prednisolone was started again,after which his serum bilirubin level became normal and the thickening of the bile duct was resolved.This case suggests that autoimmune pancreatitis can progress to other organs that are not involved at the initial diagnosis,even with sustained pancreatic remission.
文摘Bezoars are concretions of indigestible materials in the gastrointestinal tract. It generally develops in patients with previous gastric surgery or patients with delayed gastric emptying. Cases of periampullary duodenal divericular bezoar are rare. Clinical manifestations by a bezoar vary from no symptom to acute abdominal syndrome depending on the location of the bezoar. Biliary obstruction or acute pancreatitis caused by a bezoar has been rarely reported. Small bowel obstruction by a bezoar is also rare, but it is a complication that requires surgery. This is a case of acute pancreatitis and subsequent duodenal obstruction caused by a large duodenal bezoar migrating from a periampullary diverticulum to the duodenal lumen, which mimicked pancreatic abscess or microperforation on abdominal computerized tomography. The patient underwent surgical removal of the bezoar and recovered completely.
