Kopuk pankreatik kanal sendromu tanı ve tedavisi: Tek merkez deneyimi

Giriş ve Amaç: Kopuk pankreatik kanal sendromu pankreas kanalının bütünlüğünün bozulmasıyla karakterizedir. Nadir görülen bu sendrom önemli bir morbidite ve mortalite nedenidir. Biz bu çalışmada kliniğimizde kopuk pankreatik kanal sendromu tanısı olan hastaların demografik özelliklerini, endoskopik retrograd kolanjiopankreatografi bulgularını ve bu hastaların aldıkları endoskopik tedavileri araştırdık. Gereç ve Yöntem: Bu çalışma Türkiye Yüksek İhtisas Hastanesi Gastroenteroloji Kliniği, Endoskopik Retrograd Kolanjiopankreatografi Ünitesinde Ocak 2010-Ocak 2017 tarihleri arasında kopuk pankreatik kanal sendromu tanısı alan hastalarla yapıldı. Kopuk pankreatik kanal senromlu hastalar etiyolojilerindeki nedenin pankreatit olup olmamasına göre ikiye ayrıldı. Kanal rüptürü 10 hastada olmak üzere en sık pankreas boynunda izlendi. Kanal rüptürünün baş ve boyunda olduğu hastalar distal grup, gövde ve kuyrukta olduğu hastalar ise proksimal grup olarak tanımlandı. Bulgular: Toplam 17 hastada kopuk pankreatik kanal sendromu vardı. Bu hastaların yaş ortancası 46 olup 14 hasta erkek, 3 hasta kadındı. Bu hastalara toplamda 27 endoskopik retrograd kolanjiopankreatografi seansı uygulandı. Etiyolojik neden olarak 9 hastada akut pankreatit, 2 hastada kronik pankreatit, 4 hastada travma ve 2 hastada ise insülinomadan dolayı yapılan pankreatektomi etiyolojik neden olarak izlendi. Akut pankreatit öyküsü olan hastaların 5 tanesi biliyer orjinliydi. 17 hastanın 15’inde psödokist, 1 hastada ise walled-off nekroz vardı. Kanal rüptürünün distalde ve proksimalde olduğu hastalar arasında endoskopik retrograd kolanjiopankreatografi işlem sayısı ve pankreatite yol açan etiyolojik nedenler karşılaştırıldı ve anlamlı bir farklılık bulunmadı (sırasıyla p=0,215, p=0,278). Sonuç: Çalışmamızda literatürle uyumlu olarak kopuk pankreatik kanal sendromlu hastalarda en sık etiyolojik neden olarak akut pankreatit izlendi. Hastalarımızın çoğunda kopuk pankreatik kanal sendromu boyun kısmında lokalize olup bu bulgu da literatürle uyumluydu. Bu sendroma uygun tanı konulamaması ve gerekli tedavinin yapılamaması hastaların morbidite ve mortalitelerinde artışa yol açacaktır.

Diagnosis and treatment of disconnected pancreatic duct syndrome: Single center experience

Background and Aims: Disconnected pancreatic duct syndrome is characterized by the disruption. of the pancreatic duct. Although this syndrome is rare, it is an important cause of morbidity and mortality. Here we examined demographic characteristics, endoscopic retrograde cholangiopancreatography findings, and endoscopic treatment features of our patients with the diagnosis of disconnected pancreatic duct syndrome. Materials and Methods: This study was performed in the Endoscopic Retrograde Cholangiopancreatography Unit of the Türkiye Yüksek İhtisas Training and Research Hospital between January 2010 and January 2017. Patients who receive a diagnosis of disconnected pancreatic duct syndrome in an endoscopic retrograde cholangiopancreatography procedure were identified retrospectively. These patients were divided into two groups based on the location of their etiologic cause of pancreatitis. Patients with ductal distribution at the head and neck of the pancreas were defined as the distal group, whereas those with ductal distribution at the body and tail were defined as the proximal group. Results: Overall, 17 patients (median age 46, 14 males and 3 females) were included in the study. Twenty-seven endoscopic retrograde cholangiopancreatography procedures were performed in these patients. Acute pancreatitis was the etiologic cause in 9 patients. Other etiologic causes were chronic pancreatitis in 2 patients, trauma in 4 patients, and pancreatectomy in 2 patients. In acute pancreatitis, a biliary cause could be defined in 5 patients. Also, pseudocysts were diagnosed in 15 patients, whereas walled-off necrosis was diagnosed in 1 patient, and duct distribution was seen in the neck of the pancreas in 10 patients. The proximal and distal groups were not statistically different regarding both endoscopic retrograde cholangiopancreatography sessions and etiologic causes of pancreatitis (p=.215, p=.278, respectively). Conclusion: We found that acute pancreatitis is the most common etiologic cause of disconnected pancreatic duct syndrome and duct distribution was common at the neck of the pancreas similar to the literature. Both inappropriate diagnosis and delayed therapy can lead to increased morbidity and mortality in these patients.

Kaynakça

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