Internal Medicine and Critical Subacute Care Unit, Medicine Geriatric-Rehabilitation Department, University-Hospital of Parma, Parma 43126, Italy
Internal Medicine Unit, Maggiore Hospital of Bologna, Bologna 40133, Italy.
World J Gastroenterol. 2017 Dec 28;23(48):8666-8670. doi: 10.3748/wjg.v23.i48.8666.
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.
在“质子泵抑制剂时代”，穿透性消化性溃疡（PPU）是腹痛的一种特殊病因，在过去胃酸中和治疗效果不佳时更为常见。由溃疡引起的胰腺炎也非常罕见，表现为持续、剧烈的背痛放射痛。影像学检查可见胰腺周围有轻度至重度胰周液体积聚。然而，文献中仅报道了少数 PPU 与气肿性胰腺炎（EP）相关的病例。EP 是一种罕见但潜在致命的急性坏死性胰腺炎，胰腺内外有气体生长，通常累及整个胰腺实质，多见于糖尿病患者。我们在此报告一例极为罕见的十二指肠溃疡穿透胰腺并合并 EP 的病例。与涉及整个胰腺实质、预后不良的经典 EP 不同，如果及时采用保守治疗，PPU 引起的胰腺气肿性病变通常具有良性病程。气体局限于穿透部位，通常是胰头部，溃疡最常累及十二指肠。
