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Acute pancreatitis due to a duodenal ulcer.

Pyeon SI, Hwang JH, Kim YT, Lee BS, Lee SH, Lee JN, Cheong JH, Oh KJ - Clin Endosc (2014)

Bottom Line: Duodenal ulcers and acute pancreatitis are two of the most commonly encountered gastrointestinal diseases among the general population.However, duodenal ulcer-induced pancreatitis is very rarely reported worldwide.This report elaborates on a distinct medical treatment that contributes to partial or complete treatment of acute pancreatitis induced by a duodenal ulcer scar.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Busan Medical Center, Busan, Korea.

ABSTRACT
Duodenal ulcers and acute pancreatitis are two of the most commonly encountered gastrointestinal diseases among the general population. However, duodenal ulcer-induced pancreatitis is very rarely reported worldwide. This report elaborates on a distinct medical treatment that contributes to partial or complete treatment of acute pancreatitis induced by a duodenal ulcer scar.

No MeSH data available.


Related in: MedlinePlus

Findings from the second endoscopic retrograde cholangiopancreatoscopy (ERCP) 7 days after the first ERCP. (A) Before the insertion of the cannula. (B) Several attempts of cannulation were made by the use of an ERCP catheter tip before finally succeeding. (C) Seven French plastic stents were inserted in the pancreatic duct.
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Figure 5: Findings from the second endoscopic retrograde cholangiopancreatoscopy (ERCP) 7 days after the first ERCP. (A) Before the insertion of the cannula. (B) Several attempts of cannulation were made by the use of an ERCP catheter tip before finally succeeding. (C) Seven French plastic stents were inserted in the pancreatic duct.

Mentions: After the patient was transferred to a tertiary medical center, ERCP was repeated 7 days after the first ERCP. It was inferred that a pin-shaped ampulla was likely situated on the fibrotic band caused by the duodenal ulcer scar. Since it was difficult to distinguish the orifice of the ampulla by the naked eye, cannulation using an ERCP catheter tip was performed. Cannulation was successful only after several attempts (Fig. 5A, B). After an upstream injection of contrast media, the main pancreatic duct was observed, followed by the common bile duct, after delicate manipulation of the guide wire in several directions (Fig. 6). After stricture and distortion of the ampulla caused by the duodenal ulcer were diagnosed, dilatation with a 4-mm diameter endoscopic pancreatic balloon was conducted, followed by insertion of seven French plastic stents into the pancreatic duct (Fig. 5C). As there was considerable risk of cholangitis because of the narrow entrance of the distal common bile duct, endoscopic sphincterotomy was scheduled in case of fever and jaundice. Fortunately, the patient's status was stable after the procedure. After plastic stent insertion, H. pylori eradication was carried out in order to prevent duodenal ulcers in the patient who tested positive in the rapid urease test (also known as the CLOtest); proton pump inhibitor-based triple therapy comprising one proton pump inhibitor and two antibiotics, amoxicillin and clarithromycin, was used. Even though the follow-up period has not been very long, the patient has not shown any recurrence of symptoms since the removal of the plastic stent 1 month after insertion.


Acute pancreatitis due to a duodenal ulcer.

Pyeon SI, Hwang JH, Kim YT, Lee BS, Lee SH, Lee JN, Cheong JH, Oh KJ - Clin Endosc (2014)

Findings from the second endoscopic retrograde cholangiopancreatoscopy (ERCP) 7 days after the first ERCP. (A) Before the insertion of the cannula. (B) Several attempts of cannulation were made by the use of an ERCP catheter tip before finally succeeding. (C) Seven French plastic stents were inserted in the pancreatic duct.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4260110&req=5

Figure 5: Findings from the second endoscopic retrograde cholangiopancreatoscopy (ERCP) 7 days after the first ERCP. (A) Before the insertion of the cannula. (B) Several attempts of cannulation were made by the use of an ERCP catheter tip before finally succeeding. (C) Seven French plastic stents were inserted in the pancreatic duct.
Mentions: After the patient was transferred to a tertiary medical center, ERCP was repeated 7 days after the first ERCP. It was inferred that a pin-shaped ampulla was likely situated on the fibrotic band caused by the duodenal ulcer scar. Since it was difficult to distinguish the orifice of the ampulla by the naked eye, cannulation using an ERCP catheter tip was performed. Cannulation was successful only after several attempts (Fig. 5A, B). After an upstream injection of contrast media, the main pancreatic duct was observed, followed by the common bile duct, after delicate manipulation of the guide wire in several directions (Fig. 6). After stricture and distortion of the ampulla caused by the duodenal ulcer were diagnosed, dilatation with a 4-mm diameter endoscopic pancreatic balloon was conducted, followed by insertion of seven French plastic stents into the pancreatic duct (Fig. 5C). As there was considerable risk of cholangitis because of the narrow entrance of the distal common bile duct, endoscopic sphincterotomy was scheduled in case of fever and jaundice. Fortunately, the patient's status was stable after the procedure. After plastic stent insertion, H. pylori eradication was carried out in order to prevent duodenal ulcers in the patient who tested positive in the rapid urease test (also known as the CLOtest); proton pump inhibitor-based triple therapy comprising one proton pump inhibitor and two antibiotics, amoxicillin and clarithromycin, was used. Even though the follow-up period has not been very long, the patient has not shown any recurrence of symptoms since the removal of the plastic stent 1 month after insertion.

Bottom Line: Duodenal ulcers and acute pancreatitis are two of the most commonly encountered gastrointestinal diseases among the general population.However, duodenal ulcer-induced pancreatitis is very rarely reported worldwide.This report elaborates on a distinct medical treatment that contributes to partial or complete treatment of acute pancreatitis induced by a duodenal ulcer scar.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Busan Medical Center, Busan, Korea.

ABSTRACT
Duodenal ulcers and acute pancreatitis are two of the most commonly encountered gastrointestinal diseases among the general population. However, duodenal ulcer-induced pancreatitis is very rarely reported worldwide. This report elaborates on a distinct medical treatment that contributes to partial or complete treatment of acute pancreatitis induced by a duodenal ulcer scar.

No MeSH data available.


Related in: MedlinePlus