Альманах клинической медицины. 2018; 46: 542-549
Хронический панкреатит как фактор риска рака поджелудочной железы (описание клинического случая)
https://doi.org/10.18786/2072-0505-2018-46-5-542-549Аннотация
Дифференциальная диагностика хронического панкреатита (ХП) и рака поджелудочной железы (РПЖ) – острая проблема клинической практики, учитывая общность факторов риска развития этих заболеваний (курение, ожирение, сахарный диабет и инсулинорезистентность), а также высокую вероятность возникновения РПЖ на фоне ХП давностью 2–3 года, многократно возрастающую в случае генетически обусловленного ХП. В статье приведен клинический пример развития РПЖ у мужчины 60 лет спустя 3 года от начала проявлений ХП. Заболевание дебютировало с эпизода острого панкреатита, который был купирован в стационаре. Через 2 года развился острый деструктивный панкреатит, осложнившийся тромбозом воротной вены, формированием псевдокист. В дальнейшем произошел разрыв постнекротической кисты с истечением содержимого в брюшную полость, проведено хирургическое лечение. Дифференциальная диагностика между ХП и РПЖ проводилась на всех этапах обследования и лечения. Однако после купирования процессов воспаления наступил период мнимого благополучия, на фоне которого развился РПЖ. Приведенное клиническое наблюдение призвано акцентировать внимание врачей при проведении дифференциальной диагностики на важности тщательного сбора анамнеза, использования мультиспиральной компьютерной томографии с внутривенным болюсным контрастированием и эндоскопической ультрасонографии с эластографией, а в трудных случаях – на необходимости динамического контроля не реже 1 раза в 3 месяца.
Список литературы
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Almanac of Clinical Medicine. 2018; 46: 542-549
Chronic pancreatitis as a risk factor for pancreatic cancer (a clinical case)
https://doi.org/10.18786/2072-0505-2018-46-5-542-549Abstract
The differential diagnosis between chronic pancreatitis (CP) and pancreatic cancer (PC) is a challenging issue in the clinical practice, taking into account common risk factors shared by these disorders (smoking, obesity, diabetes mellitus and insulin resistance), as well as a high risk of PC development against the underlying CP of 2 to 3 years' duration; this risk would be manifold in hereditary CP. The article presents a clinical case of PC in a 60-year old man at three years after he had been diagnosed with CP. The disease manifested from an acute episode of pancreatitis, which was treated in a hospital. Two years later, the patient suffered from acute destructive pancreatitis complicated by portal vein thrombosis and formation of pseudocysts. Subsequently, there was a rupture of the post-necrotic cyst with leakage into the abdominal cavity; this required surgical intervention. The differential diagnosis between CP and PC was done at all steps of the diagnostic work-up and treatment. However, afterthe inflammation resolved, there was a period of apparent well-being, during which the patient developed PC. This clinical case is intended to draw attention of clinicians, while making differential diagnosis, to the detailed past history assessment, use of multiaxial computed tomography with intravenous bolus contrast enhancement, and endoscopic ultrasound examination with elastography. In difficult cases, regular follow-up of at least every three months would be necessary.
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