A CASE OF LOCALIZED PANCREATITIS WITH DUODENAL STRICTURE

We experienced a case of localized pancreatitis which presented difficulty in diagnosis because we had to treat primarily a stricture of the descending portion of the duodenum which provoked strong clinical findings. A 57-year-old man was seen at the hospital because of epigastric pain. Endoscopic examination revealed a shallow ulcerative lesion with crater at the retrobulbar region. No malignant evidence was found on a biopsy and conservative therapy was started. But no remission was attained and the patient was admitted to the hospital. Hypotention duodenoscopy visualized a severe stricture in the descending portion of duodenum. Abdominal ultrasonography and CT revealed a tumorous lesion about 4cm in diameter at the head of pancreas and thickening of hte duodenal wall. No abnormality was noted on endoscopic retrograde cholangiopancreascopy (ERCP). Since we could not completely rule out a possibility of malignant disease and the stricture findings and abdominal signs were clinically strong, the patient was operated on. During operation a hard mass was palpated in the upper portion of the pancreatic head. Intraoperative frozen section diagnosis indicated no malignancy, but a pacreatoduodenectomy was performed. Pathological study revealed that the tumor was localized chronic pancreatitis with inflammatory infiltration into the duodenal wall.