Acute Obstructive Suppuration of the Pancreatic Duct Causing Sepsis

Objective: We report a rare case of acute obstructive suppuration of the pancreatic duct causing sepsis, which was successfully treated with emergent endoscopic retrograde cholangiopancreatography (ERCP). Methods: We describe the patient’s clinical presentation, laboratory test results, and imaging used for diagnosis and treatment. Results: A 33-year-old female with a history of recurrent acute pancreatitis was admitted during an episode of acute pancreatitis. Computed tomography (CT) scan of the abdomen revealed acute pancreatitis, diffuse pancreatic atrophy and pancreatic ductal dilatation with obstruction due to a soft tissue lesion within the distal duct. Shortly after admission she developed symptoms and signs of sepsis. Urgent ERCP was performed to further assess the suspected cholangitis. “Clean” bile emanated from the common bile duct, while copious purulent fluid was detected at the dilated pancreatic duct orifice, confirming suppuration of the pancreatic duct. A plastic single pigtail stent was placed traversing the ampulla and pancreatic duct stones that were causing the obstruction, which were later removed. After endoscopic decompression, the patient rapidly improved over the following 24 hours and had no subsequent admissions for pancreatitis.Conclusion: Acute suppuration of the pancreatic duct (ASPD) is a rare and potentially fatal infectious complication of pancreatic ductal obstruction with few cases reported in the English literature. It would be of interest to further investigate the exact pathophysiology leading to development of ASPD. The endoscopic methods of urgent ERCP and pancreatic duct decompression utilized in our case proved effective in successfully treating ASPD. This unusual condition should be considered in patients with acute pancreatitis who develop early clinical decompensation.