Diagnosis And Treatment Of Intraductal Papillary Mucinous Neoplasms With Acute Pancreatitis As First Symptom:An Analysis Of 11 Cases

Objective : To investigate the clinical manifestations,diagnosis and treatment of pancreatic intraductal papillary mucinous neoplasm(IPMN)with acute pancreatitis as the first symptom.Methods:Retrospective analysis of 11 clinical data of 11 patients with pancreatic intraductal papillary mucinous neoplasm(IPMN)with acute pancreatitis as the first symptom admitted to the First Affiliated Hospital of China Medical University from January 2008 to January 2018.Results:Combined with medical history,symptoms,clinical manifestations,serum amylase/lipase assay and B-ultrasound,CT,MRCP and other imaging examinations;11 patients were admitted to hospital for acute pancreatitis(AP)or severe acute pancreatitis(SAP).Combined with imaging examination,9 cases of tumor in the head of the pancreas,1 case in the neck of the pancreas and 1 case in the tail of the pancreas were diagnosed as intraductal papillary mucinous neoplasms(IPMN)by imaging,cytology and pathology.One case was treated with severe acute pancreatitis(SAP)complicated with multiple organ dysfunction syndrome(MODS)into the intensive care unit ICU;one patient was not treated because of advanced age,poor cardiopulmonary function and anesthesia.2case underwent spleen and pancreatic body resection,and 7 underwent pancreaticoduodenectomy.All patients underwent postoperative paraffin pathology to confirm IPMN;2 cases were branched pancreatic duct type IPMN,7 The main pancreatic duct type IPMN,2 cases of mixed IPMN,1case of IPMN-related invasive carcinoma;1 case of pancreaticoduodenectomy patients with viral hepatitis,cirrhosis and other basic diseases,postoperative Liver failure,abdominal bleeding Anastomotic fistula and other complications,and the emergence of hemorrhagic shock in the first 66 days after surgery,the family refused treatment,requiring back a local hospital,the follow-up died the following day from the hospital.The remaining 8 patients were discharged from the 13 th to 50 th day after surgery.The average postoperative hospital stay was 27 days.The patients were followed up.The patients were followed up by telephone and outpatient visits after leaving the hospital.One patient was lost to follow-up and 9 patients were lost.The patients were followed up for 4 months to 5 years.All of the 9 patients survived to date.One patient had intestinal obstruction at 4 months after surgery and was admitted to our hospital for emergency treatment.Postoperative CT was considered for postoperative adhesion insufficiency obstruction.The possibility is large,and the intestinal obstruction is cured after conservative symptomatic treatment.Conclusions:The diagnosis of pancreatic intraductal papillary mucinous neoplasm(IPMN)is difficult.IPMN with acute pancreatitis as the first symptom is rare.In the process of treatment of acute pancreatitis,the diagnosis and treatment of ipmn are often neglected;clinical work should be combined with early diagnosis of clinical manifestations,laboratory tests and imaging examinations,and the best treatment plan should be adopted for different patients to prevent the progression of pancreatitis.The deterioration has brought the greatest benefit to the treatment of patients.