Gastroenterology Medicine Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan.
Department of Pathology, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan.
Clin J Gastroenterol. 2020 Aug;13(4):591-596. doi: 10.1007/s12328-020-01104-9. Epub 2020 Feb 20.
A 75-year-old man was referred to our hospital due to a huge pancreatic cyst. Computed tomography revealed a monocular cyst 15 cm in size without a solid mass lesion nearby. He was diagnosed with pancreatic pseudocyst. Endoscopic ultrasound (EUS)-guided drainage was planned for the next day due to abdominal distension; however, the pseudocyst ruptured into the peritoneal cavity before treatment could be applied. To prevent the progression of peritonitis, EUS-guided drainage of the pseudocyst was performed. A nasocystic tube and plastic stent were placed into the ruptured cyst via the gastric wall through the same puncture tract. After the treatment, the cyst rapidly decreased in size, and the peritonitis improved without surgery. The patient's serum IgG4 level was found to be elevated to 820 mg/dL. Endoscopic retrograde cholangiopancreatography revealed main pancreatic duct stricture without obstruction. No communication between the main pancreatic duct and the pseudocyst was found. An EUS-guided fine-needle aspiration biopsy of the hypoechoic site was performed, revealing IgG4-positive plasma cell infiltration. He was finally diagnosed with AIP associated with the rupture of a pseudocyst. Oral corticosteroid (30 mg/day) treatment was started and gradually tapered. There has been no recurrence in the 28 months since the initiation of treatment.
一位 75 岁男性因巨大胰腺囊肿就诊于我院。计算机断层扫描显示，直径 15cm 的单房性囊肿，附近无实性肿块病变。诊断为胰腺假性囊肿。由于腹胀，计划次日行内镜超声（EUS）引导下引流，但假性囊肿在治疗前破裂至腹腔。为防止腹膜炎进展，行 EUS 引导下假性囊肿引流术。通过同一穿刺道，经胃壁将鼻囊肿管和塑料支架置入破裂的囊肿内。治疗后，囊肿迅速缩小，腹膜炎改善，无需手术。患者血清 IgG4 水平升高至 820mg/dL。内镜逆行胰胆管造影显示主胰管狭窄但无阻塞。主胰管与假性囊肿之间无交通。对低回声部位行 EUS 引导下细针抽吸活检，显示 IgG4 阳性浆细胞浸润。最终诊断为 AIP 合并假性囊肿破裂。开始口服皮质类固醇（30mg/天）治疗，并逐渐减量。治疗开始后 28 个月内无复发。
