Obstructive pancreatitis secondary to a pancreatic metastasis from lung cancer treated with nasopancreatic drainage

  • Shinya KawaguchiEmail author
  • Takuya Ohtsu
  • Shuzo Terada
  • Shinya Endo
Case Report


A 44- and a 66-year-old woman underwent nasopancreatic drainage (NPD) to treat obstructive pancreatitis secondary to a pancreatic metastasis from lung cancer. Both patients were diagnosed with stage IV lung cancer and underwent chemotherapy for 17 and 15 months, respectively. Abdominal ultrasonography and computed tomography revealed a solid pancreatic tail tumor measuring 2.5 cm and 1.3 cm in diameter, respectively. Additionally, we observed dilatation of the upstream main pancreatic duct (MPD) and edematous parenchyma with peripancreatic inflammatory changes limited to the pancreatic tail. Both patients were diagnosed with moderately severe acute pancreatitis and received fluid resuscitation, an opioid analgesic, antibiotics, and a protease inhibitor. However, owing to unrelenting pain, we performed endoscopic retrograde cholangiopancreatography (ERCP) for pancreatic duct drainage in both patients. ERCP showed a stricture in the MPD in the pancreatic tail with upstream dilatation. A 5-Fr NPD tube was inserted to drain the dilated MPD, and cloudy pancreatic juice was drained. NPD tube placement led to pain relief in both patients. Pancreatic juice cultures grew Enterococcus faecium and Enterobacter cloacae, respectively. The NPD tube was later cut in both cases using a pair of scissor forceps.


Obstruction of the pancreatic duct Bacterial infection Pancreatic metastasis Nasopancreatic drainage Pain relief 


Compliance with ethical standards

Conflict of interest

Shinya Kawaguchi, Takuya Ohtsu, Shuzo Terada and Shinya Endo declare that they have no conflict of interest.


  1. 1.
    Ito T, Takada R, Omoto S, et al. Analysis of prognostic factors in pancreatic metastases: a multicenter retrospective analysis. Pancreas. 2018;47:1033–9.CrossRefGoogle Scholar
  2. 2.
    Line DH, Deeley TJ. The necropsy findings in carcinoma of the bronchus. Br J Dis Chest. 1971;65:238–42.CrossRefGoogle Scholar
  3. 3.
    Yeung K-Y, Haidak DJ, Brown JA, et al. Metastasis-induced acute pancreatitis in small cell bronchogenic carcinoma. Arch Intern Med. 1979;139:552–4.CrossRefGoogle Scholar
  4. 4.
    Kenneth CS, William JD, John DU. Metastases-induced acute pancreatitis as the initial manifestation of bronchogenic carcinoma. Chest. 1993;104:98–100.CrossRefGoogle Scholar
  5. 5.
    Wienman DS. Acute suppuration of the pancreatic duct. Gastrointest Endosc. 1995;41:268–70.CrossRefGoogle Scholar
  6. 6.
    Marotta F, Tajiri H, Li ZL, et al. Pure pancreatic juice from patients with chronic pancreatitis has an impaired antibacterial activity. Int J Pancreatol. 1997;22:215–20.Google Scholar
  7. 7.
    Kondo H, Naitoh I, Okumura F, et al. Clinical features of acute obstructive suppurative pancreatic ductitis: a retrospective review of 20 cases. J Gastroenterol Hepatol. 2016;31:1366–73.CrossRefGoogle Scholar
  8. 8.
    Shimizuguchi R, Kikuyama M, Kamisawa T, et al. Acute obstructive suppurative pancreatic ductitis (AOSPD) in pancreatic cancer treated by nasopancreatic drainage. Clin J Gastroenterol. 2018;11:315–9.CrossRefGoogle Scholar
  9. 9.
    Laukkarinen JM, Weiss ER, van Acker GJ, et al. Protease activated receptor-2 exerts contrasting model-specific effects on acute experimental pancreatitis. J Biol Chem. 2008;283:20703–12.CrossRefGoogle Scholar
  10. 10.
    Shinya Kawaguchi M, Kikuyama T, Satoh, et al. Use of nasopancreatic drainage for severe post-endoscopic retrograde cholangiopancreatography pancreatitis: a case series. Intern Med. 2018;57:2657–62.CrossRefGoogle Scholar
  11. 11.
    Wehrmann T, Riphaus A, Frenz MB, et al. Endoscopic pancreatic duct stenting for relief of pancreatic cancer pain. Eur J Gastroenterol Hepatol. 2005;17:1395–400.CrossRefGoogle Scholar
  12. 12.
    Fei Gao S, Ma N, Zhang, et al. Clinical efficacy of endoscopic pancreatic drainage for pain relief with malignant pancreatic duct obstruction. Asian Pac J Cancer Prev. 2014;15:6823–7.CrossRefGoogle Scholar
  13. 13.
    Costamagna G, Mutignani M, Lngrosso M, et al. Endoscopic treatment of postsurgical external pancreatic fistulas. Endoscopy. 2001;33:317–22.CrossRefGoogle Scholar
  14. 14.
    Rana SS, Bhasin DK, Nanda M, et al. Endoscopic transpapillary drainage for external fistulas developing after surgical or radiological pancreatic interventions. J Gastroenterol Hepatol. 2010;25:1087–92.CrossRefGoogle Scholar
  15. 15.
    Kozarek RA, Ball TJ, Patterson DJ, et al. Transpapillary stenting for pancreaticocutaneous fistulas. J Gastrointest Surg. 1997;1:357–61.CrossRefGoogle Scholar
  16. 16.
    Yuji Nishi I, Naitoh T, Nakazawa, et al. Use of a scissors forceps for the endoscopic removal of a distally migrated self-expandable metallic stent adhering to the duodenal mucosa. Endoscopy. 2015;47(S 01):E98–9.Google Scholar

Copyright information

© Japanese Society of Gastroenterology 2019

Authors and Affiliations

  1. 1.Department of GastroenterologyShizuoka General HospitalShizuokaJapan

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