Upper abdominal pain recurrent attack for 5 years, the cause is difficult to break? And see how to diagnose under the ultrasound endoscopy.

Common causes of !---- acute pancreatitis include gallstone, alcoholic, hyperlipidemia, and tumorsbut there is a type of pancreatitis, the disease is repeated, and through a variety of means of examination are difficult to find a clear cause, then what should be done? It is hoped that today's case will make us realize the diagnostic significance of ultrasound endoscopy (EUS) in recurrent pancreatitis and reduce misdiagnosiscase analysis patient son, 53 years old, repeated abdominal pain for 5 yearsfive years ago patients without obvious causes of upper abdominal swelling pain, local hospitals to check blood amylase 600U / L, enhanced CT indicates the end of the pancreas full, pancreatic tube slightly dilated, consider acute pancreatitisto treat the disease and get betterAfterdue to repeated abdominal pain symptoms, the average seizure of 2-3 times a year, there is no obvious cause, the local hospital to consider "chronic recurrent pancreatitis", has received endoscopy retrograde pancreatic bile duct imaging (ERCP) and pancreatic tube stent inlet 3 timesthe symptoms of patients were significantly alleviated after each implantation of the pancreatic tube stentbut the good times were not long, in December 2018 patients due to re-in-patient "acute pancreatitis" visitsenhanced CT: pancreatic tube stent placement state, pancreatic tube significantly expanded compared to the previous; ring sweep EUS: pancreatic echo thickening, pancreatic tube expansion, no stent, consider for chronic pancreatitis;consider papilloma (IPMN) in the pancreas catheter? Chronic pancreatitis? Re-run pancreatic tube stent placement surgery, post-operative pancreatitis symptoms than more frequent, an average of 1 time per monthpatients were admitted to hospital for further treatmentthe characteristics of the medical history 1relapse acute pancreatitis, iexclusiveiditability; 2pancreatic tube dilation is anterior aggravation; 3early pancreatic tube stent can relieve symptoms, after shedding symptoms repeatedly; 4The recent stent placement effect is not good image data to the past image data: I see EUS: pancreatic tube full expansion, the internal stent in the position of the main pancreatic tube can be seen a large number of flocculatal mucus-like structure, part of the body part of the pancreas tube is dog-like staggered, the pipe wall can detect and multiple low echo nodules injection in the sac wall low echo nodules appear to strengthen the signal, the degree is weak erasing the pancreas sEU diagnosis main analysis pancreatic tube IPMN, cancer? Case thinking patients repeated pancreatitis attacks, imaging performance is the expansion of the main pancreatic tube, the previous diagnosis is considered as chronic pancreatitis, but the cause is unknown the recent pancreatitis attacks were significantly more frequent than before, and the effect of pancreatic tube stent placement was poor, indicating the high-pressure state of the pancreatic tube caused by other factors further vertical EUS observed a large amount of mucus and nodules in the catheter, thus conforming to the typical primary pancreatic tube intra-catheter papilloma (IPMN), with no exception for cancerous surgical pathology pancreatic catheter nipple-like mucus tumor (IPMN, intestinal type, main pancreatic tube type- mainly) with immersion cancer, the composition of the cancer is gum-like cancer, the maximum diameter of 7mm experience, common causes of acute pancreatitis include gallstone disease, alcoholicdisease, hyperlipidemia and tumors , about 20% of patients through various means of examination can not find a clear cause, the disease is often repeated, clinically known as iexclusiveist pancreatitis the vast majority of patients with recurrent pancreatitis have undergone one or even several rounds of imaging tests, but the results are mostly negative and the practice of the center of my hospital shows that most patients are often due to a certain mutation or abnormal changes in the pancreatic bile duct, such as panIN, the diameter of the pancreas is less than 0.5cm, the diameter of the pancreas catheter is less than 1cm, the tube-like papilloma (ITPN) in the pancreas duct, etc these subtle changes can be formed can directly block the pancreatic tube, or secretia mucus and other caused by the pancreatic tube drainage is not smooth, causing too much accumulation of the pantry and the pancreas itself digestion, which is the cause of acute pancreatitis an important reason IPMN: due to the high column epithelial growth caused by excessive production of mucus, while the epithelial secretion ion function defects, resulting in mucus thick blocking the pancreatic tube to form cysts can be divided into main pancreatic tube type (MD), branch edilean tube type (BD), mixed type (Mix-type) depending on the affected pancreatic tube the main pancreatic tube type grows in the main pancreas tube, resulting in the continuous expansion of the main pancreas tube, branch pancreatic tube type grows in the same branch pancreatic tube as the main pancreatic tube, so only causes the branch pancreatic tube to expand into a cystic pattern, and the main pancreas tube generally does not dilate clinically recurrent pancreatitis for the main pancreatic tube type IPMN, which is easily confused with chronic pancreatitis The key to its diagnosis is that the mucus-like structure and wall nodules can be seen in the expanding main pancreas and chronic pancreatitis can appear the main pancreatic tube expansion, most can be seen high echo pancreatic tube stone formation, the real atrophy of the pancreas, small leaf-like mesh-like changes use the dynamic personalized scan of EUS to truly show the subtle structure of the lesions and find the real cause of pancreatitis in short, for recurrent pancreatitis, pancreatic tube expansion, placement of pancreatic tube stent can alleviate symptoms, but always can not ignore the diagnosis of the cause of the differential diagnosis choose a favorable diagnostic tool is key Yang Xiuji Chen Ke Yang health source: complex endoscopy, !-- content display end- !-- to determine whether the login ends.