Acute obstructive suppurative pancreatic ductitis (AOSPD) with duodenal obstruction treated by pancreaticoduodenectomy (PD): a rare case report

We report a rare case of acute obstructive suppurative pancreatic ductitis (AOSPD) accompanied by duodenal obstruction in a patient with chronic pancreatitis (CP). A woman in her 40s was admitted to our hospital for intermittent abdominal distension, epigastric pain, and vomiting, which worsened during the previous 6 months. Gastroscopy showed incomplete pyloric obstruction, and computed tomography (CT) revealed calcification in the enlarged head of the pancreas, dilation of the main pancreatic duct (MPD), and thickening of both the gastric antrum and duodenal walls. The patient was preoperatively diagnosed as having an inflamed head of the pancreas, with a stone, and duodenal obstruction. Pancreaticoduodenectomy (PD) was performed to resolve the duodenal obstruction and remove the pancreatic stone. While transecting the neck of the pancreas, frank pus began to flow from the MPD, and the pus was drained and collected. Bacterial culture of the purulent pancreatic juice revealed the presence of Escherichia coli, confirming AOSPD. The patient’s symptoms were relieved, and she recovered fully, after the surgery. In conclusion, AOSPD associated with duodenal obstruction can be treated successfully by PD.