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Obstructive pancreatitis secondary to a pancreatic metastasis from lung cancer treated with nasopancreatic drainage

  • Shinya KawaguchiEmail author
  • Takuya Ohtsu
  • Shuzo Terada
  • Shinya Endo
Case Report
  • 8 Downloads

Abstract

A 44- and a 66-year-old woman underwent nasopancreatic drainage (NPD) to treat obstructive pancreatitis secondary to a pancreatic metastasis from lung cancer. Both patients were diagnosed with stage IV lung cancer and underwent chemotherapy for 17 and 15 months, respectively. Abdominal ultrasonography and computed tomography revealed a solid pancreatic tail tumor measuring 2.5 cm and 1.3 cm in diameter, respectively. Additionally, we observed dilatation of the upstream main pancreatic duct (MPD) and edematous parenchyma with peripancreatic inflammatory changes limited to the pancreatic tail. Both patients were diagnosed with moderately severe acute pancreatitis and received fluid resuscitation, an opioid analgesic, antibiotics, and a protease inhibitor. However, owing to unrelenting pain, we performed endoscopic retrograde cholangiopancreatography (ERCP) for pancreatic duct drainage in both patients. ERCP showed a stricture in the MPD in the pancreatic tail with upstream dilatation. A 5-Fr NPD tube was inserted to drain the dilated MPD, and cloudy pancreatic juice was drained. NPD tube placement led to pain relief in both patients. Pancreatic juice cultures grew Enterococcus faecium and Enterobacter cloacae, respectively. The NPD tube was later cut in both cases using a pair of scissor forceps.

Keywords

Obstruction of the pancreatic duct Bacterial infection Pancreatic metastasis Nasopancreatic drainage Pain relief 

Notes

Compliance with ethical standards

Conflict of interest

Shinya Kawaguchi, Takuya Ohtsu, Shuzo Terada and Shinya Endo declare that they have no conflict of interest.

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Copyright information

© Japanese Society of Gastroenterology 2019

Authors and Affiliations

  1. 1.Department of GastroenterologyShizuoka General HospitalShizuokaJapan

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