Korean J Gastroenterol.  2009 Jun;53(6):383-387. 10.4166/kjg.2009.53.6.383.

A Case of Autoimmune Pancreatitis Combined with Extensive Involvement of Biliary Tract

• Lee CM
• Roh MH
• Jung CK
• Won JJ
• Baek YH
• Lee SW
• Choi SR
• Cho JH

• KMID: 1792757
• DOI: http://doi.org/10.4166/kjg.2009.53.6.383

Abstract

Autoimmune pancreatitis is a distinct disease characterized by the presence of autoantibodies and hypergammaglobulinemia, inflammation of the pancreatic parenchyma, and irregular stricture of the pancreatic duct. The involvement of distal common bile duct is frequently observed, but intrahepatic bile duct involvement is very rare, which seem to have similar feature to primary sclerosing cholangitis. We report a case of the patient with autoimmune pancreatitis combined with extensive involvement of extrahepatic and intrahepatic bile duct, which had a favorable response to steroid therapy.

Keyword

Autoimmune pancreatitis; Bile duct

MeSH Terms

Aged
Autoimmune Diseases/complications/*diagnosis/drug therapy
Bile Ducts, Extrahepatic/*radiography
Bile Ducts, Intrahepatic/*radiography
Humans
Male
Pancreatitis/complications/*diagnosis/radiography
Prednisolone/therapeutic use
Tomography, X-Ray Computed

Figure

• 

  Fig. 1. CT and ERCP findings before steroid treatment. (A) CT scan demonstrated intrahepatic biliary dilatation secondary to diffuse stricturing of the biliary system and bile duct wall thickening at hilar portion (black arrows). (B) CT showed diffuse pancreatic enlarge-ment (asterisk) with homogenous texture and without calcification or stone. (C) Cholangiogram showed a complex hilar stricture and dif-fusely irregular intrahepatic biliary strictures (white arrows). (D) Pancreatogram showed diffuse and irregular narrowing of the entire main pancreatic duct (head arrows).

• 

  Fig. 2. CT and ERCP findings after 4 weeks of steroid treatment. CT scan demonstrated (A) the appearance of intrahepatic biliary tree was significantly improved (black arrows) and (B) the size of pancreas markedly decreased and returned to normal (asterisk). ERCP shows (C) dramatic resolution of the stricture of the intrahepatic duct and hilar portion (white arrows) and (D) normalized main pancreatic duct (head arrows) were observed.

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