A Case of Obstructive Jaundice Diagnosed as Chronic Pancreatitis with Narrowing of the Major Pancreatic Duct

Takafumi Machimoto, Hajime Nakamura, Yoshiharu Sakai, Kazuichi Okazaki^* and Yoshio Yamaoka

Department of Gastroenterological Surgery, Graduate School of Medicine, Kyoto University
Department of Gastroenterological Medicine, Graduate School of Medicine, Kyoto University^*

We report a case of autoimmune-related chronic pancreatitis with narrowing of the major pancreatic duct. A 37-year-old man was admitted with complaints of epigastralgia. On admission, an abdominal CT showed diffuse swelling of the pancreas without any dilatation of the main pancreatic duct. Serum amylase level was elevated to 345IU/L and the diagnosis of acute pancreatitis was made. However, obstructive jaundice appeared thereafter and abdominal CT and US revealed dilatation of the common bile duct. ERCP showed no choledocolithiasis and smooth narrowing of the lower bile duct and the major pancreatic duct. A tentative diagnosis of chronic pancreatitis with narrowing of the major pancreatic duct was made, and we investigated the relation with autoimmune disease. Anti-Lactoferrin antibody was positive, and then gluco-corticoid therapy was started. Two weeks later and six months later, ERCP showed improvement in the narrowing of the common bile duct and the major pancreatic duct. Recently, a new disease entity of "chronic pancreatitis with narrowing of the major pancreatic duct" was reported. This is a kind of autoimmune disease and treated effectively by glucocorticoids. We surgeons should be well aware of this kind of disease entity, and when we encounter such cases, we should consider the indication of surgery after examining the possibility of improvement by means of glucocorticoid therapy

Key words
chronic pancreatitis, autoimmune disease, glucocorticoid therapy

Reprint requests
Takafumi Machimoto Department of Surgery, Shizuoka Municipal Hospital 10-93 Oite-machi, Shizuoka, 420-8630 JAPAN

Accepted
July 28, 1999

To read the PDF file you will need Abobe Reader installed on your computer.