Abstract
A 44- and a 66-year-old woman underwent nasopancreatic drainage (NPD) to treat obstructive pancreatitis secondary to a pancreatic metastasis from lung cancer. Both patients were diagnosed with stage IV lung cancer and underwent chemotherapy for 17 and 15 months, respectively. Abdominal ultrasonography and computed tomography revealed a solid pancreatic tail tumor measuring 2.5 cm and 1.3 cm in diameter, respectively. Additionally, we observed dilatation of the upstream main pancreatic duct (MPD) and edematous parenchyma with peripancreatic inflammatory changes limited to the pancreatic tail. Both patients were diagnosed with moderately severe acute pancreatitis and received fluid resuscitation, an opioid analgesic, antibiotics, and a protease inhibitor. However, owing to unrelenting pain, we performed endoscopic retrograde cholangiopancreatography (ERCP) for pancreatic duct drainage in both patients. ERCP showed a stricture in the MPD in the pancreatic tail with upstream dilatation. A 5-Fr NPD tube was inserted to drain the dilated MPD, and cloudy pancreatic juice was drained. NPD tube placement led to pain relief in both patients. Pancreatic juice cultures grew Enterococcus faecium and Enterobacter cloacae, respectively. The NPD tube was later cut in both cases using a pair of scissor forceps.
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References
Ito T, Takada R, Omoto S, et al. Analysis of prognostic factors in pancreatic metastases: a multicenter retrospective analysis. Pancreas. 2018;47:1033–9.
Line DH, Deeley TJ. The necropsy findings in carcinoma of the bronchus. Br J Dis Chest. 1971;65:238–42.
Yeung K-Y, Haidak DJ, Brown JA, et al. Metastasis-induced acute pancreatitis in small cell bronchogenic carcinoma. Arch Intern Med. 1979;139:552–4.
Kenneth CS, William JD, John DU. Metastases-induced acute pancreatitis as the initial manifestation of bronchogenic carcinoma. Chest. 1993;104:98–100.
Wienman DS. Acute suppuration of the pancreatic duct. Gastrointest Endosc. 1995;41:268–70.
Marotta F, Tajiri H, Li ZL, et al. Pure pancreatic juice from patients with chronic pancreatitis has an impaired antibacterial activity. Int J Pancreatol. 1997;22:215–20.
Kondo H, Naitoh I, Okumura F, et al. Clinical features of acute obstructive suppurative pancreatic ductitis: a retrospective review of 20 cases. J Gastroenterol Hepatol. 2016;31:1366–73.
Shimizuguchi R, Kikuyama M, Kamisawa T, et al. Acute obstructive suppurative pancreatic ductitis (AOSPD) in pancreatic cancer treated by nasopancreatic drainage. Clin J Gastroenterol. 2018;11:315–9.
Laukkarinen JM, Weiss ER, van Acker GJ, et al. Protease activated receptor-2 exerts contrasting model-specific effects on acute experimental pancreatitis. J Biol Chem. 2008;283:20703–12.
Shinya Kawaguchi M, Kikuyama T, Satoh, et al. Use of nasopancreatic drainage for severe post-endoscopic retrograde cholangiopancreatography pancreatitis: a case series. Intern Med. 2018;57:2657–62.
Wehrmann T, Riphaus A, Frenz MB, et al. Endoscopic pancreatic duct stenting for relief of pancreatic cancer pain. Eur J Gastroenterol Hepatol. 2005;17:1395–400.
Fei Gao S, Ma N, Zhang, et al. Clinical efficacy of endoscopic pancreatic drainage for pain relief with malignant pancreatic duct obstruction. Asian Pac J Cancer Prev. 2014;15:6823–7.
Costamagna G, Mutignani M, Lngrosso M, et al. Endoscopic treatment of postsurgical external pancreatic fistulas. Endoscopy. 2001;33:317–22.
Rana SS, Bhasin DK, Nanda M, et al. Endoscopic transpapillary drainage for external fistulas developing after surgical or radiological pancreatic interventions. J Gastroenterol Hepatol. 2010;25:1087–92.
Kozarek RA, Ball TJ, Patterson DJ, et al. Transpapillary stenting for pancreaticocutaneous fistulas. J Gastrointest Surg. 1997;1:357–61.
Yuji Nishi I, Naitoh T, Nakazawa, et al. Use of a scissors forceps for the endoscopic removal of a distally migrated self-expandable metallic stent adhering to the duodenal mucosa. Endoscopy. 2015;47(S 01):E98–9.
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Shinya Kawaguchi, Takuya Ohtsu, Shuzo Terada and Shinya Endo declare that they have no conflict of interest.
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Kawaguchi, S., Ohtsu, T., Terada, S. et al. Obstructive pancreatitis secondary to a pancreatic metastasis from lung cancer treated with nasopancreatic drainage. Clin J Gastroenterol 12, 382–386 (2019). https://doi.org/10.1007/s12328-019-00944-4
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DOI: https://doi.org/10.1007/s12328-019-00944-4