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An adult female case of autoimmune pancreatitis with gastric outlet obstruction complicated by annular pancreas

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Abstract

A 65-year-old woman presented with epigastric pain persisting for more than 3 months. She was diagnosed with autoimmune pancreatitis (AIP), based on high serum IgG4 levels (981 mg/dL) and diffuse pancreatic enlargement with a capsule-like rim on computed tomography (CT). Additionally, the main pancreatic duct was indistinct on magnetic resonance cholangiopancreatography. CT, esophagogastroduodenoscopy, and upper gastrointestinal radiography revealed stenosis with gastric outlet obstruction (GOO) in the second part of the duodenum. Prednisolone administration was initiated as treatment; on day 3 of treatment, the patient’s symptoms improved. After 2 weeks, CT and endoscopic ultrasonography of the duodenal bulbs revealed improvement of the enlarged pancreas. The second part of the duodenum ran into the pancreatic head, and no malignant lesions were observed. Based on the above findings, we suspect that she developed AIP in the annular pancreas (AnnP), where duodenal stenosis worsened with diffuse pancreatic enlargement, resulting in GOO. She is currently under careful observation with tapering of prednisolone—without surgical treatment for AnnP. The pathogenesis of GOO caused by AIP without malignancy is rare. One case of GOO caused by AIP, wherein AIP developed in the AnnP (similar to the present case), has been reported, highlighting the novelty of our report.

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References

  1. Okazaki K, Kawa S, Kamisawa T, et al. Amendment of the Japanese consensus guidelines for autoimmune pancreatitis, 2020. J Gastroenterol. 2022;57:225–45.

    Article  Google Scholar 

  2. Lecco TM. Zur Morphologie des pancreas aeFnnulare. Sitzungsb Akad Wissensch. 1910;119:391–406.

    Google Scholar 

  3. Zyromski NJ, Sandoval JA, Pitt HA, et al. Annular pancreas: dramatic differences between children and adults. J Am Coll Surg. 2008;206:1019–25.

    Article  Google Scholar 

  4. NagPal SJS, Peeraphatdit T, Sannapaneni SK, et al. Clinical spectrum of adult patients with annular pancreas: findings from a large single institution cohort. Pancreatology. 2019;19:290–5.

    Article  Google Scholar 

  5. Kawa S, Kamisawa T, Notohara K, et al. Japanese clinical diagnostic criteria for autoimmune pancreatitis, 2018: revision of Japanese clinical diagnostic criteria for autoimmune pancreatitis, 2011. Pancreas. 2020;49:e13–4.

    Article  Google Scholar 

  6. Alkhayyat M, Bachour S, Abou Saleh M, et al. The epidemiology of annular pancreas in the United States: a population-based study. J Clin Gastroenterol. 2022;56:186–91.

    Article  Google Scholar 

  7. Kubota K, Kamisawa T, Okazaki K, et al. Low-dose maintenance steroid treatment could reduce the relapse rate in patients with type 1 autoimmune pancreatitis: a long-term Japanese multicenter analysis of 510 patients. J Gastroenterol. 2017;52:955–64.

    Article  CAS  Google Scholar 

  8. Oyama G, Tomita M, Matsuo T, et al. Autoimmune pancreatitis with bowel obstruction caused by proximal jejunal stricture: a case report. Nihon Shokakibyo Gakkai Zasshi. 2019;116:256–64.

    Google Scholar 

  9. Rana SS, Gupta P, Sharma R, et al. A rare cause of reversible gastric outlet obstruction. Indian J Gastroenterol. 2018;37:469–71.

    Article  Google Scholar 

  10. Rana SS, Bhasin DK, Rao C, et al. Autoimmune pancreatitis presenting with gastric outlet obstruction. Gastrointest Endosc. 2012;75:1122–3.

    Article  Google Scholar 

  11. Tomiyama T, Uchida K, Matsushita M, et al. Comparison of steroid pulse therapy and conventional oral steroid therapy as initial treatment for autoimmune pancreatitis. J Gastroenterol. 2011;46:696–704.

    Article  CAS  Google Scholar 

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Acknowledgements

We would like to thank Editage (www.editage.com) for English language editing.

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Authors and Affiliations

  1. Department of Gastroenterology, Shizuoka General Hospital, 4-27-1, Kita-Ando, Aoi-Ku, Shizuoka-City, Shizuoka, 420-8527, Japan

    Kazuhisa Asahara, Shinya Kawaguchi, Shodai Takeda, Shinya Ikeda, Tatsunori Satoh, Shuzo Terada, Shinya Endo & Naofumi Shirane

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  1. Kazuhisa Asahara
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  2. Shinya Kawaguchi
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  3. Shodai Takeda
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  4. Shinya Ikeda
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  5. Tatsunori Satoh
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  6. Shuzo Terada
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  7. Shinya Endo
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  8. Naofumi Shirane
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Correspondence to Shinya Kawaguchi.

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Asahara, K., Kawaguchi, S., Takeda, S. et al. An adult female case of autoimmune pancreatitis with gastric outlet obstruction complicated by annular pancreas. Clin J Gastroenterol 16, 110–115 (2023). https://doi.org/10.1007/s12328-022-01727-0

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  • DOI: https://doi.org/10.1007/s12328-022-01727-0

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