Kobayashi Rumiko, Matsumoto Satohiro, Yoshida Yukio
Rumiko Kobayashi, Satohiro Matsumoto, Yukio Yoshida, Department of Gastroenterology, Saitama Medical Center, Jichi Medical University, Saitama 330-8503, Japan.
World J Gastroenterol. 2014 Jun 21;20(23):7514-7. doi: 10.3748/wjg.v20.i23.7514.
A 25-year-old man was admitted with the chief complaints of right flank pain, watery diarrhea, and fever. Blood tests revealed high levels of inflammatory markers, and infectious enteritis was diagnosed. A stool culture obtained on admission revealed no growth of any significant pathogens. Conservative therapy was undertaken with fasting and fluid replacement. On day 2 of admission, the fever resolved, the frequency of defecation reduced, the right flank pain began to subside, and the white blood cell count started to decrease. On hospital day 4, the frequency of diarrhea decreased to approximately 5 times per day, and the right flank pain resolved. However, the patient developed epigastric pain and increased blood levels of the pancreatic enzymes. Abdominal computed tomography revealed mild pancreatic enlargement. Acute pancreatitis was diagnosed, and conservative therapy with fasting and fluid replacement was continued. A day later, the blood levels of the pancreatic enzymes peaked out. On hospital day 7, the patient passed stools with fresh blood, and Campylobacter jejuni/coli was detected by culture. Lower gastrointestinal endoscopy performed on hospital day 8 revealed diffuse aphthae extending from the terminal ileum to the entire colon. Based on the findings, pancreatitis associated with Campylobacter enteritis was diagnosed. In the present case, a possible mechanism of onset of pancreatitis was invasion of the pancreatic duct by Campylobacter and the host immune responses to Campylobacter.
一名25岁男性因右侧胁腹疼痛、水样腹泻和发热为主诉入院。血液检查显示炎症标志物水平升高，诊断为感染性肠炎。入院时进行的粪便培养未发现任何重要病原体生长。采取禁食和补液的保守治疗。入院第2天，发热消退，排便次数减少，右侧胁腹疼痛开始减轻，白细胞计数开始下降。住院第4天，腹泻次数减少至每天约5次，右侧胁腹疼痛消失。然而，患者出现上腹部疼痛，胰腺酶血液水平升高。腹部计算机断层扫描显示胰腺轻度肿大。诊断为急性胰腺炎，继续采用禁食和补液的保守治疗。一天后，胰腺酶血液水平达到峰值。住院第7天，患者排出带鲜血的粪便，培养检测出空肠弯曲菌/结肠弯曲菌。住院第8天进行的下消化道内镜检查显示，从回肠末端到整个结肠有弥漫性口疮。根据这些发现，诊断为弯曲菌肠炎相关性胰腺炎。在本病例中，胰腺炎发病的一种可能机制是弯曲菌侵入胰管以及宿主对弯曲菌的免疫反应。
