Clinical insights and management strategies for acute obstructive suppurative pancreatic ductitis: a retrospective study of 82 rare cases.

BACKGROUND AND AIMS

Acute obstructive suppurative pancreatic ductitis (AOSPD) is a rare condition with limited diagnostic and treatment information. In this study, we sought to expand understanding by analyzing the clinical characteristics and management of AOSPD.

METHODS

We analyzed 81 AOSPD cases (1993-2024) from the literature and 1 case from the First Affiliated Hospital of Anhui Medical University. Additionally, 60 acute-on-chronic pancreatitis (CP) cases from our hospital were matched and compared with AOSPD with CP in demographics, laboratory findings, and imaging results.

RESULTS

Sixty-six AOSPD patients (80.5%) were men, and the median patient age was 60 years. CP was present in 60 patients (73.2%), whereas 18 (22.0%) had pancreatic tumors. Pancreatic juice cultures were positive in 47 patients (90.4%). Key treatments included endoscopic pancreatic stent placement in 44 patients (53.7%) and endoscopic nasopancreatic drainage in 31 (37.8%). All follow-up patients showed clinical improvement. Compared with acute-on-CP, AOSPD with CP was more prevalent in older men with a history of pancreaticobiliary intervention, alcohol consumption, and smoking. AOSPD with CP patients typically presented with fever, elevated white blood cell counts, increased C-reactive protein levels, pancreatic stones, and dilated pancreatic ducts. Interestingly, a lower proportion of AOSPD with CP patients exhibited elevated serum amylase levels (P < .05).

CONCLUSIONS

AOSPD primarily affects middle-aged and elderly men with CP and prior pancreaticobiliary intervention. Imaging and pancreatic juice culture aid diagnosis. Compared with acute-on-CP, AOSPD with CP displays distinct clinical characteristics. Timely and accurate diagnosis and treatment can lead to favorable short-term outcomes for patients with AOSPD.