Abstract：
Acute obstructive suppurative pancreatic ductitis (AOSPD) is an acute suppuration of the pancreatic duct. Endoscopic retrograde cholangiopancreatography (ERCP) drainage and intravenous antibiotics treatment is the mainstay of therapy. Herein we describe an extremely rare case of AOSPD leading to pyogenic spondylitis. A 61-year-old male with a past medical history of chronic pancreatitis and diabetes mellitus presented to our hospital with abdominal and dorsal pain, fever, and shock status. Laboratory data showed severe inflammation, disseminated intravascular coagulation, and normal pancreatic enzymes. Computed tomography showed dilated main pancreatic duct and surrounding pancreatic abscesses. Spinal abnormalities were not detected at this point. He was initially diagnosed as infected pancreatic pseudocyst, but did not respond well to conservative intravenous antibiotic treatment. ERCP performed one week later revealed purulent pancreatic juice and the diagnosis was changed to AOSPD. Upon ERCP, we experienced technical difficulty in passing obstructing calculi. However, successful pancreatic drainage was achieved using new dilation and penetration devices. The patient responded quickly to drainage, but later developed pyogenic spondylitis. Our case highlights the difficulty of diagnosing AOSPD, the usefulness of new devices in urgent endoscopic drainage, and underscores the possibility of progression of pyogenic spondylitis even after adequate treatment.
摘要：
急性梗阻性化脓性胰腺炎（AOSPD）是胰管的急性化脓。内镜逆行胰胆管造影术（ERCP）引流和静脉抗生素治疗是治疗的主要手段。在这里，我们描述了导致化脓性脊柱炎的AOSPD极为罕见的病例。一名61岁男性，既往有慢性胰腺炎和糖尿病病史，因腹部和背部疼痛来我院就诊，发烧,和休克状态。实验室数据显示严重的炎症,弥散性血管内凝血,和正常的胰腺酶.计算机断层扫描显示主胰管扩张和周围胰腺脓肿。此时未检测到脊柱异常。他最初被诊断为胰腺假性囊肿，但对保守的静脉抗生素治疗反应不佳.一周后进行ERCP检查发现胰液呈脓性，诊断改为AOSPD。在ERCP，我们在通过阻碍结石方面遇到了技术上的困难。然而,使用新的扩张和穿透装置成功进行胰腺引流.病人对引流反应迅速，但后来发展为化脓性脊柱炎。我们的案例凸显了诊断AOSPD的困难，新装置在紧急内窥镜引流中的有用性，并强调即使经过适当的治疗，化脓性脊柱炎进展的可能性。
