UCTN – Unusual cases and technical notes E195 Severe acute pancreatitis following endoscopic biopsy of the minor duodenal papilla Fig. 2 Contrast-en- hanced CT imaging revealed diffuse peri- pancreatic and bilateral parietocolic fat necro- sis. Fig. 1 Contrast-enhanced computed tomo- graphic (CT) imaging revealed pancreatic necrosis of more than 50% of the gland. Fig. 4 CT imaging at 6 weeks shows a large pseudocyst measuring 13 8.5 cm at the level of the pancreatic body and tail. Fig. 3 Coronal magnetic resonance chol- angiopancreatography imaging revealed pan- creas divisum: the dorsal duct (arrowhead) draining independently into the first duode- num (minor papilla), superior and anterior to the common bile duct (arrow). A woman aged 57 was admitted with a 3- nal papilla. At the same time colonoscopy weeks a CT scan showed a large pseudo- This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited. month history of moderate right upper found the primary tumor – a 20-mm ul- cyst at the level of the pancreatic body quadrant abdominal pain. Abdominal ul- cerated adenocarcinoma in the left colon. and tail (l" Fig. 4) and progression of liver trasonography revealed multiple solid Four hours after the endoscopy proce- metastasis. The patient was unresponsive liver nodules. Computed tomography dures, the patient complained of abdomi- to systemic chemotherapy. Two weeks (CT) of the thorax, abdomen, and pelvis nal pain. Serum amylases, lipases, and C- later (8 weeks after the acute pancreati- confirmed liver metastases with no ob- reactive protein were increased to 20–30 tis) the patient died from right atrial com- vious primary tumor. Serum biochemis- times the normal values. CT scan showed pression secondary to liver metastases. try showed only a mild increase in g-glu- grade E severe acute pancreatitis (Baltha- An asymptomatic rise in amylase concen- tamyl transpeptidase. Carcinoembryonic zar score) (l" Figs. 1 and 2) [1]. The Ran- tration can be observed after 30% of pa- antigen and CA19–9 were increased to son score was 6 at 48 hours after admis- pilla biopsies [3]. A single case of mild 60–80 times the normal values. Esopha- sion [2]. Magnetic resonance cholangio- pancreatitis was reported after papilla gogastroduodenoscopy revealed Helico- pancreatography diagnosed a complete biopsy in a patient with Gardner’s syn- bacter pylori-positive erosive gastritis pancreas divisum (l" Fig. 3). drome [4]. Papillary edema due to biopsy and duodenal mucosal hyperplasia after After 4 weeks of intensive care the patient may obstruct the pancreatic duct causing biopsy of a suspiciously enlarged duode- resumed normal alimentation. At 6 pancreatitis; this probably happens more Gincul R et al. Severe acute pancreatitis following endoscopic biopsy of the minor duodenal papilla… Endoscopy 2009; 41: E195 –E196 E196 UCTN – Unusual cases and technical notes easily in the minor papilla in complete References Bibliography pancreas divisum [5]. As far as we know 1 Balthazar EJ, Robinson DL, Megibow AJ et al. DOI 10.1055/s-0029-1214796 this is the first case of severe acute pan- Acute pancreatitis: value of CT in establish- Endoscopy 2009; 41: E195–E196 ing prognosis. Radiology 1990; 174: 331– Georg Thieme Verlag KG Stuttgart · New York · creatitis after duodenal papilla biopsy. 336 ISSN 0013-726X 2 Ranson J. Etiological and prognostic factors Endoscopy_UCTN_Code_CPL_1AH_2AB in human acute pancreatitis: a review. Am Corresponding author J Gastroenterol 1982; 77: 633– 638 R. Gincul, MD 1 1 1 3 Saurin J, Gutknecht C, Napoleon B et al. Sur- R. Gincul , M. Ciocirlan , J. Dumortier , Pavillon H bis 1 2 3 veillance of duodenal adenomas in familial B. Guerrier , J. M. Comte , A. Faure , adenomatous polyposis reveals high cumu- Hôpital Edouard Herriot 3 4 2 A. Levrat , F. Pilleul , B. Napoleon , lative risk of advanced disease. J Clin Oncol 69437 Lyon Cedex 03 T. Ponchon1 2004; 22: 493 – 498 France 1 Service de GastroentØrologie, Hôpital 4 Morales T, Hixson M. Acute pancreatitis fol- Fax: 00 33 472110147 lowing endoscopic biopsy of the ampulla [email protected] Edouard Herriot, Hospices Civils de Lyon, in a patient with Gardner’s syndrome. Gas- France trointest Endosc 1994; 40: 367– 369 2 UnitØ de GastroentØrologie, Hôpital 5 Lerch M, Saluja A, Runzi M et al. Pancreatic PrivØ Jean Mermoz, Lyon, France duct obstruction triggers acute pancreatitis 3 Service de RØanimation MØdicale et in the opossum. Gastroenterology 1993; 104: 853 – 861 Chirurgicale, Hôpital Edouard Herriot, Hospices Civils de Lyon, France 4 Service de Radiologie Digestive, Hôpital Edouard Herriot, Hospices Civils de Lyon, France This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited. Gincul R et al. Severe acute pancreatitis following endoscopic biopsy of the minor duodenal papilla… Endoscopy 2009; 41: E195 –E196.