Obstructive pancreatolithiasis in a cat with triaditis and concurrent hypercalcaemia

Case summary A 7-year-old neutered female domestic longhair cat was presented for further investigation of suspected hepatobiliary disease. Increases in serum 1,2-o-dilauryl-rac-glycero-3-glutaric acid-(6'-methylresorufin) ester lipase and hepatobiliary enzymes, with concurrent hypoalbuminaemia, were documented on blood biochemistry. Abdominal ultrasonography findings were consistent with acute pancreatitis with multiple pancreatoliths visualised within the pancreatic duct. Treatment for suspected triaditis was initiated with a hydrolysed protein diet, amoxicillin–clavulanate, hepatoprotectants and buprenorphine. Fifty-three days later, the patient presented with hypercalcaemia and obstructive pancreatolithiasis, and was euthanased. Post-mortem examination revealed severe chronic active pancreatitis with moderate chronic lymphocytic, plasmacytic cholangiohepatitis and mild chronic lymphocytic–plasmacytic duodenal enteritis (triaditis). Multiple calcium carbonate pancreatoliths present within the pancreatic ducts had resulted in pancreatic duct obstruction. Relevance and novel information Pancreatolithiasis is a very rare condition in cats, with only five reports to date. In human medicine, pancreatolithiasis is often a sequala to chronic pancreatitis, seen in up to 50–90% of patients. However, in cats the aetiology of pancreatolithiasis, and indeed chronic pancreatitis, is poorly understood. This report describes a case of obstructive pancreatolithiasis in a cat with histopathological confirmation of triaditis and is the first report of hypercalcaemia in a cat with obstructive pancreatolithiasis. This further adds to the evidence base that pancreatolithiasis may have a similar pathogenesis to humans and can develop secondarily to chronic pancreatitis in cats.

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Duodenal Adenocarcinoma Diagnosed from a Biopsy Specimen of a Depressed Lesion Obtained by Magnifying Endoscopy

Case Reports in Gastroenterology ◽

10.1159/000444441 ◽

2016 ◽

Vol 10 (1) ◽

pp. 166-172

Author(s):

Minoru Tomizawa ◽

Fuminobu Shinozaki ◽

Yasufumi Motoyoshi ◽

Takao Sugiyama ◽

Shigenori Yamamoto ◽

...

Keyword(s):

Pancreatic Duct ◽

Biopsy Specimen ◽

Muscularis Propria ◽

Magnifying Endoscopy ◽

Pancreatic Ducts ◽

Papilla Of Vater ◽

Duodenal Adenocarcinoma ◽

Abdominal Ultrasonography ◽

Elevated Lesion ◽

Depressed Lesion

Biopsies are necessary for the management of duodenal tumors. However, the most suitable targets for biopsy are not known. An 82-year-old woman who regularly visited our hospital for rheumatoid arthritis underwent abdominal ultrasonography. This screening revealed a dilated pancreatic duct. Magnetic resonance cholangiopancreatography was performed, and dilatation of the pancreatic duct was confirmed. The patient underwent duodenoscopy to investigate the possibility of obstruction of the papilla of Vater. The examination revealed an elevated lesion around the papilla of Vater. Endoscopic ultrasonography and a 20-MHz mini-probe were used to investigate the depth of the invasion. The common bile and pancreatic ducts were intact. The mucosal and submucosal borders were indistinct; however, the border between the submucosa and muscularis propria was clear, suggesting that the muscularis propria was intact. Magnifying endoscopy was used to examine the surface of the elevated lesion, which revealed a depressed lesion. A biopsy specimen of the depressed lesion was taken, and the tumor was diagnosed as an adenocarcinoma. Another biopsy specimen from a non-depressed lesion was diagnosed as an adenoma. The patient was diagnosed with duodenal adenocarcinoma, and was recommended surgery. She declined surgery and was followed up for 34 months. Because it is possible for depressed lesions of duodenal tumors to be adenocarcinomas, biopsy specimens should be obtained from depressed lesions of duodenal tumors.

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Combined minimaly invasive surgery of pancreaticolithiasis in combination with congenital stricture of the terminal sections of the pancreatic ducts

Pediatrician (St Petersburg) ◽

10.17816/ped8596-102 ◽

2017 ◽

Vol 8 (5) ◽

pp. 96-102

Author(s):

Mikhail P. Korolev ◽

Leonid E. Fedotov ◽

Ruben G. Avanesyan ◽

Elena A. Mikhailova ◽

Georgiy M. Lepekhin ◽

...

Keyword(s):

Chronic Pancreatitis ◽

Magnetic Resonance ◽

Minimally Invasive ◽

Pancreatic Duct ◽

Correct Diagnosis ◽

Clinical Manifestations ◽

Pancreatic Ducts ◽

Invasive Treatment ◽

Percutaneous Access ◽

Joint Application

Chronic pancreatitis with pancreatic hypertension is extremely rare in childhood. Chronic pancreatitis in this age is usually always associated with a сongenital defect of the pancreatic duct system. The article describes the case of long-term clinical observation and minimally invasive treatment of chronic calculous pancreatitis, first diagnosed in a girl at the age of 16 years. Despite the fact that clinical manifestations were observed from the age of 3 years, the correct diagnosis could be made only at the age of 16, by joint application of ultrasound, Magnetic Resonance Imaging (MRI) and Magnetic Resonance Cholangiopancreatography (MRCP). The cause of chronic pancreatitis were concrements and strictures of the main and additional pancreatic ducts that caused pancreatic hypertension. Attempt of endoscopic retrograde lithoextraction from the pancreatic ducts was impossible because of the presence of severe stricture. Therefore, it was decided to apply a combined approach using percutaneous access under ultrasound navigation. The patient underwent series of minimally invasive combined procedures including the lithoextraction, balloon dilatation and transcutaneous drainage of the pancreatic ducts with the endoscopic and percutaneous access with ultrasound and radiologic control. For the prevention of restenosis, the antegrade stenting of the main pancreatic duct with self-expanding coated nitinol stent was used with further removal of the stent. Due to the treatment, there was no pancreatitis within 5 years after stent removal.

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Motion - Pancreatic Endoscopy is Useful for the Pain of Chronic Pancreatitis: Arguments for the Motion

Canadian Journal of Gastroenterology ◽

10.1155/2003/518084 ◽

2003 ◽

Vol 17 (1) ◽

pp. 57-59

Author(s):

Stanley M Branch

Keyword(s):

Chronic Pancreatitis ◽

Pancreatic Duct ◽

Endoscopic Therapy ◽

Clinical Problem ◽

Pancreatic Pseudocysts ◽

Pancreatic Ducts ◽

Success Rates ◽

Long Term Follow Up

Pain is the dominant clinical problem in patients with chronic pancreatitis. It can be due to pseudocysts, as well as strictures and stones in the pancreatic ducts. Most experts agree that obstruction could cause increased pressure within the main pancreatic duct or its branches, resulting in pain. Endoscopic therapy aims to alleviate pain by reducing the pressure within the ductal system and draining pseudocysts. Approaches vary according to the specific nature of the problem, and include transgastric, transduodenal and transpapillary stenting and drainage. Additional techniques for the removal of stones from the pancreatic duct include extracorporeal shockwave lithotripsy. Success rates for stone extraction and stenting of strictures are high in specialized centres that employ experienced endoscopists, but pain often recurs during long term follow-up. Complications include pancreatitis, bleeding, infection and perforation. In the case of pancreatic pseudocysts, percutaneous or even surgical drainage should be considered if septae or large amounts of debris are present within the lesion. This article describes the techniques, indications and results of endoscopic therapy of pancreatic lesions.

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Overlap and cumulative effects of pancreatic duct obstruction, abnormal pain processing and psychological distress on patient-reported outcomes in chronic pancreatitis

Gut ◽

10.1136/gutjnl-2021-325855 ◽

2021 ◽

pp. gutjnl-2021-325855

Author(s):

Søren S Olesen ◽

Anna E Phillips ◽

Mahya Faghih ◽

Louise Kuhlmann ◽

Emily Steinkohl ◽

...

Keyword(s):

Psychological Distress ◽

Chronic Pancreatitis ◽

Pancreatic Duct ◽

Pain Processing ◽

Related Factors ◽

Duct Obstruction ◽

Pancreatic Duct Obstruction ◽

Pain Catastrophising ◽

Patient Reported

ObjectiveSeveral factors have been suggested to mediate pain in patients with chronic pancreatitis. However, it is unknown whether these factors are overlapping and if they have cumulative effects on patient-reported outcomes (PROs).DesignWe performed a multicentre cross-sectional study of 201 prospectively enrolled subjects with definitive chronic pancreatitis. All subjects underwent evaluation for pancreatic duct obstruction, abnormalities in pain processing using quantitative sensory testing, and screening for psychological distress (anxiety, depression and pain catastrophising) based on validated questionnaires. Abnormality was defined by normal reference values. PROs included pain symptom severity (Brief Pain Inventory short form) and quality of life (EORTC-QLQ-C30 questionnaire). Associations between pain-related factors and PROs were investigated by linear trend analyses, multiple regression models and mediation analyses.ResultsClinical evaluation suggestive of pancreatic duct obstruction was observed in 29%, abnormal pain processing in 23%, anxiety in 47%, depression in 39% and pain catastrophising in 28%; each of these factors was associated with severity of at least one PRO. Two or more factors were present in 51% of subjects. With an increasing number of factors, there was an increase in pain severity scores (p<0.001) and pain interference scores (p<0.001), and a reduction in quality of life (p<0.001). All factors had independent and direct effects on PROs, with the strongest effect size observed for psychological distress.ConclusionPain-related factors in chronic pancreatitis are often present in an overlapping manner and have a cumulative detrimental effect on PROs. These findings support a multidisciplinary strategy for pain management.Trial registration numberThe study was registered with ClinicalTrials.gov (NCT03434392).

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A Review of Pancreatico-Pleural Fistula in Pancreatitis and Its Management

HPB Surgery ◽

10.1155/1992/90415 ◽

1992 ◽

Vol 5 (2) ◽

pp. 79-86 ◽

Cited By ~ 25

Author(s):

N. A. Burgess ◽

H. E. Moore ◽

J. O. Williams ◽

M. H. Lewis

Keyword(s):

Pancreatic Duct ◽

Pleural Cavity ◽

Surgical Intervention ◽

Rare Condition ◽

Pancreatic Enzymes ◽

Emergency Laparotomy ◽

Duct Obstruction ◽

Pancreatic Duct Obstruction

Pancreatico-pleural fistula is a rare condition in which pancreatic enzymes drain directly in to the pleural cavity, most commonly from an enlarging pseudocyst. We review the literature on the causes, investigations and treatment of pancreatico-pleural fistulae and compare this with our own experience of the case of a 41 year old man with a left sided pancreatico-pleural fistula associated with pancreatic duct obstruction. The fistula could not be demonstrated by USS, CT or ERCP, and after these investigations the patient was managed conservatively. However, deterioration in the patients' condition led to an urgent but not emergency laparotomy and operative pancreatogram. This demonstrated the distally obstructed pancreatic duct, with associated pleural fistula for which aggressive surgical intervention was indicated. The patient subsequently completely recovered.

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Analysis of the Effects of Stent Insertion and the Factors Related to Stent Retrieval in Chronic Pancreatitis Accompanying Main Pancreatic Duct Obstruction

Gut and Liver ◽

10.5009/gnl.2007.1.1.63 ◽

2007 ◽

Vol 1 (1) ◽

pp. 063-067

Author(s):

Chang Hoon Kim ◽

Seungmin Bang ◽

Kyung Ho Song ◽

Jeong Youp Park ◽

Tae Joo Jeon ◽

...

Keyword(s):

Chronic Pancreatitis ◽

Pancreatic Duct ◽

Main Pancreatic Duct ◽

Stent Insertion ◽

Duct Obstruction ◽

Stent Retrieval ◽

Pancreatic Duct Obstruction

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The Use of Neoprene in Experimental Pancreatitis

Revista de Chimie ◽

10.37358/rc.19.2.6983 ◽

2019 ◽

Vol 70 (2) ◽

pp. 676-678

Author(s):

Alexandru Grigorovici ◽

cristian Velicescu ◽

Delia Hinganu ◽

Alina Calin ◽

Marius Valeriu Hinganu ◽

...

Keyword(s):

Experimental Study ◽

Acute Pancreatitis ◽

Chronic Pancreatitis ◽

Pancreatic Duct ◽

Genetically Modified ◽

Pancreatic Tissue ◽

Experimental Pancreatitis ◽

Pancreatic Ducts ◽

Genetically Modified Animals

The concept of chronic pancreatitis has been stated in our country much later than acute pancreatitis. This manuscript proposes a synthesis of the etiopathogenic, diagnostic and therapeutic data in chronic pancreatitis based on actual information correlated with the results of our experimental study. The experiment was conducted on 18 animals, in which was performed the intraduodenal ligation of the pancreatic duct apertures and the obstruction of the pancreatic ducts with intraparenchymatous, intraoperative neoprene injections. We investigated the lesions by using intraoperative pancreatic tissue collected after injections. The results encourage us to continue the research and to choose genetically modified animals because are closer to the human one.

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Sites of Pancreatic Duct Obstruction in Chronic Pancreatitis

Annals of Surgery ◽

10.1097/00000658-195907000-00005 ◽

1959 ◽

Vol 150 (1) ◽

pp. 49-56 ◽

Cited By ~ 11

Author(s):

ALAN P. THAL ◽

BERNARD GOOTT ◽

ALEXANDER R. MARCULIS

Keyword(s):

Chronic Pancreatitis ◽

Pancreatic Duct ◽

Duct Obstruction ◽

Pancreatic Duct Obstruction

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Ansa pancreatica: a rare cause of acute recurrent episode in chronic pancreatitis

BJR|case reports ◽

10.1259/bjrcr.20200044 ◽

2020 ◽

pp. 20200044

Author(s):

Hind Guerroum ◽

Amal Rami ◽

Mariam Kassimi ◽

Jihane Habi ◽

Rahmouni Imane ◽

...

Keyword(s):

Chronic Pancreatitis ◽

Pancreatic Duct ◽

Anatomic Variation ◽

Magnetic Resonance Cholangiopancreatography ◽

Pancreatic Ducts ◽

Predisposing Factor ◽

Minor Papilla ◽

Head Of The Pancreas ◽

Ansa Pancreatica

Ansa pancreatica is a rare anatomic variation of pancreatic ducts. It is a predisposing factor of recurrent pancreatitis. In this case report, we describe a case of a 24-year-old male suffering from an ansa pancreatica with a non-patent major papilla, diagnosed on magnetic resonance cholangiopancreatography (MRCP).The ansa pancreatica was revealed by an episode of acute pancreatitis attacks in chronic pancreatitis. Endoscopic retrograde cholangiopancreatography (ERCP) confirmed important abrupt dilation in the main pancreatic duct with an ansa loop in the pancreatic duct in the head of the pancreas, and a sphincterotomy of the minor papilla was performed. The procedure was difficult and the placement of a long-term pancreatic stent during the ERCP was impossible, thus a surgical pancreatico-jejunostomy was proposed as a treatment of an ansa pancreatica with a non-patent major papilla.

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