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Seltene Ursache einer rezidivierenden, nekrotisierenden Pankreatitis

Rare cause of recurring necrotising pancreatitis

Der Chirurg volume 79, pages 252–257 (2008)Cite this article

Zusammenfassung

Hintergrund

Die nekrotisierende Pankreatitis kann eine schwere Komplikation einer Pankreasgangabflussstörung z. B. durch Steine, Tumorstenose oder bei Pancreas divisum sein. Alkohol- und Nikotinkonsum gelten als Risikofaktoren der Chronifizierung.

Patientin und Verlauf

Bei einer 63-jährigen Patientin mit o. g. Risikofaktoren, einem Pancreas divisum und vermeintlichem zystischen Pankreasschwanztumor, der sich als Pseudozyste bei einer Pankreatitis herausstellte, erfolgte eine 2-jährige Behandlung rezidivierender Pankreatitisschübe. Erst bei der Behandlung eines komplizierenden Leberabszesses fiel in einer CT eine malignitätssuspekte, zum Aufstau des Pankreashauptganges führende Pankreaskopfraumforderung auf. Retrospektiv waren Gangveränderungen schon auf Voraufnahmen sichtbar. Die partielle Duodenopankreatektomie bestätigte das Pankreaskopfkarzinom.

Schlussfolgerung

Gerade eine lange Zeit rezidivierende Pankreatitis erfordert, auch seltene Ursachen wie einen Tumor in Betracht zu ziehen. Hilfreich dafür ist – abgesehen von der Fokussierung auf die aktuelle jeweilige Komplikation, hier der Pankreasschwanzpankreatitis –, die vermeintlich unerheblichen Befunde des restlichen Organs nicht außer Acht zu lassen.

Abstract

Background

Necrotising pancreatitis may develop as a consequence of pancreatic duct obstruction by stones, tumors or in the presence of a pancreas divisum. Alcohol and nicotine are regarded as risk factors for the disease becoming chronic.

Patient and course of the disease

A 63-year-old female patient with suspected cystadenocarcinoma of the pancreas tail, which was resolved as a pancreatic pseudocyst, was treated for recurrent pancreatitis for 2 years. A tumor in the pancreas head was only detected on a follow-up CT after resection of a complicating liver abscess. In retrospect, progressive pancreatic duct anomalies were visible on previous scans. Partial duodenopancreatectomy confirmed the presence of a pancreas head carcinoma.

Conclusion

Continuous critical re-evaluation of all potential causes of pancreatitis including rare conditions, such as a tumor, is required particularly if pancreatitis recurs over a long period. Re-evaluation of studies over time and of findings apart from the actual main focus of the complication, in this case pancreatitis of the pancreas tail, may help to detect the underlying disease instead of just treating the consequences.

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Affiliations

  1. Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universität Ulm, Steinhövelstraße 9, 89075, Ulm, Deutschland

    G. Leder, A. Formentini & D. Henne-Bruns

  2. Klinik für Diagnostische und Interventionelle Radiologie, Universität Ulm, Ulm, Deutschland

    M. Hoffmann

Authors
  1. G. Leder
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  2. A. Formentini
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  3. M. Hoffmann
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  4. D. Henne-Bruns
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Correspondence to G. Leder.

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Leder, G., Formentini, A., Hoffmann, M. et al. Seltene Ursache einer rezidivierenden, nekrotisierenden Pankreatitis. Chirurg 79, 252–257 (2008). https://doi.org/10.1007/s00104-007-1415-4

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  • DOI: https://doi.org/10.1007/s00104-007-1415-4

Schlüsselwörter

  • Pankreatitis
  • Pankreaskarzinom
  • Pancreas divisum
  • Leberabszess
  • Pankreasgangstenose

Keywords

  • Pancreatitis
  • Pancreatic cancer
  • Pancreas divisum
  • Liver abscess
  • Pancreatic duct stenosis