Wallis de Vries B M, ter Borg E, Eeftinck Schattenkerk M, Eddes E H
Deventer Ziekenhuis, Postbus 5ooi, 7400 GC Deventer.
Ned Tijdschr Geneeskd. 2005 Oct 1;149(40):2232-7.
A pylorus-sparing pancreaticoduodenectomy was performed in a 67-year-old man because of indications for a carcinoma of the distal common bile duct. Histology of the postoperative specimen, however, revealed a sclerosing inflammation of the distal common bile duct and the surrounding pancreatic parenchyma. Initial postoperative recovery was followed by recurrent cholangitis. Stenosis of the choledocho-jejunostomy could not be demonstrated. Instead, repeated endoscopic retrograde cholangiopancreaticography revealed extensive sclerosis of the intrahepatic bile ducts, which suggested a sclerosing cholangitis associated with an autoimmune pancreatitis: sclerosing autoimmune pancreaticocholangitis. This disorder was recently described; it is characterised by a disorder in the pancreas that is indistinguishable from malignancy by imaging techniques and that is followed by a sclerosing inflammation of the bile ducts. The disease responds well to steroids. The patient described demonstrated a complete clinical and biochemical recovery after initiation ofprednisone therapy.
一名67岁男性因远端胆总管癌的指征接受了保留幽门的胰十二指肠切除术。然而，术后标本的组织学检查显示远端胆总管和周围胰腺实质存在硬化性炎症。术后初期恢复后出现复发性胆管炎。未发现胆总管空肠吻合口狭窄。相反，反复的内镜逆行胰胆管造影显示肝内胆管广泛硬化，提示与自身免疫性胰腺炎相关的硬化性胆管炎：硬化性自身免疫性胰胆管炎。这种疾病最近被描述；其特征是胰腺疾病在影像学上与恶性肿瘤难以区分，随后出现胆管硬化性炎症。该疾病对类固醇治疗反应良好。所述患者在开始泼尼松治疗后实现了临床和生化完全恢复。
