Tana C, Silingardi M, Giamberardino MA, Cipollone F, Meschi T, Schiavone C. Emphysematous pancreatitis associated with penetrating duodenal ulcer. World J Gastroenterol 2017; 23(48): 8666-8670 [PMID: 29358874 DOI: 10.3748/wjg.v23.i48.8666]
Corresponding Author of This Article
Claudio Tana, MD, Internal Medicine and Critical Subacute Care Unit, Medicine Geriatric-Rehabilitation Department, University-Hospital of Parma, Via Antonio Gramsci 14, Parma 43126, Italy. ctana@ao.pr.it
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Dec 28, 2017; 23(48): 8666-8670 Published online Dec 28, 2017. doi: 10.3748/wjg.v23.i48.8666
Emphysematous pancreatitis associated with penetrating duodenal ulcer
Claudio Tana, Mauro Silingardi, Maria Adele Giamberardino, Francesco Cipollone, Tiziana Meschi, Cosima Schiavone
Claudio Tana, Tiziana Meschi, Internal Medicine and Critical Subacute Care Unit, Medicine Geriatric-Rehabilitation Department, University-Hospital of Parma, Parma 43126, Italy
Mauro Silingardi, Internal Medicine Unit, Maggiore Hospital of Bologna, Bologna 40133, Italy
Maria Adele Giamberardino, Francesco Cipollone, Ce.S.I.-Met, “G. D’Annunzio” University of Chieti, Chieti 66100, Italy
Maria Adele Giamberardino, Francesco Cipollone, Geriatrics Clinic, Department of Medicine and Science of Aging, “G. D’Annunzio” University of Chieti, Chieti 66100, Italy
Francesco Cipollone, Regional Center for the Study of Atherosclerosis, Hypertension and Dyslipidemia, “SS Annunziata” Hospital - ASL Chieti, Chieti 66100, Italy
Cosima Schiavone, Unit of Internistic Ultrasound, Department of Medicine and Science of Aging, “G. D’Annunzio” University of Chieti, Chieti 66100, Italy
Author contributions: All of the authors had access to the data and a role in writing the manuscript.
Informed consent statement: All the procedures performed were in agreement with standard clinical practice.The patient gave the consent for publication.
Conflict-of-interest statement: The authors declare no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Claudio Tana, MD, Internal Medicine and Critical Subacute Care Unit, Medicine Geriatric-Rehabilitation Department, University-Hospital of Parma, Via Antonio Gramsci 14, Parma 43126, Italy. ctana@ao.pr.it
Telephone: +39-521-704442 Fax: +39-522-704442
Received: September 13, 2017 Peer-review started: September 14, 2017 First decision: September 27, 2017 Revised: October 5, 2017 Accepted: October 17, 2017 Article in press: October 17, 2017 Published online: December 28, 2017 Processing time: 104 Days and 21.5 Hours
Abstract
In the “proton pump inhibitors era”, a penetrating peptic ulcer (PPU) represents an exceptional cause of abdominal pain, and was more frequently observed in the past where there was not an effective antacid treatment. Ulcer-induced pancreatitis is very rare, too, and manifests with persistent, intense pain radiating to the back. A mild to severe pancreatitis with peripancreatic fluid collection can be observed at imaging. However, only a few cases of association between PPU and emphysematous pancreatitis (EP) have been published in the literature. EP is a rare but potentially fatal form of acute necrotizing pancreatitis in which gas grows in and outside the pancreas, and typically involves the whole parenchyma in diabetic individuals.
Here we report an extremely rare case of a duodenal ulcer penetrating the pancreas and complicated with EP. Unlike the classic form of EP, which involves the whole parenchyma and has a poor prognosis, we found that the emphysematous involvement of the pancreas by PPU has a benign course if a conservative therapy is promptly established. Gas is confined to the site of penetration, usually the pancreatic head, and ulcers most often involve the duodenum.
Core tip: Penetrating peptic ulcers (PPU) represent an extremely rare cause of abdominal pain, and can sometimes manifest with mild to severe acute pancreatitis. However, only a few cases of association between PPU and emphysematous pancreatitis (EP) have been published so far in the literature. Here we report an extremely rare case of a duodenal ulcer penetrating the pancreas and complicated with EP. Unlike the classic form of EP, which involves the whole parenchyma and has a poor prognosis, we found that the focal emphysematous involvement of the pancreas by PPU has a benign clinical course if an appropriate therapy is promptly established.
