Clinical Insights and Management Strategies for Acute Obstructive Suppurative Pancreatic Ductitis: A Retrospective Study of 82 Rare Cases

Acute obstructive suppurative pancreatic ductitis (AOSPD) is a rare condition with limited diagnostic and treatment information. This study aims to expand understanding by analyzing the clinical characteristics and management of AOSPD. We analyzed 81 AOSPD cases (1993-2024) from the literature and 1 case from the First Affiliated Hospital of Anhui Medical University. Additionally, 60 acute-on-chronic pancreatitis (CP) cases from our hospital were matched and compared with AOSPD with CP in demographics, laboratory findings, and imaging results. The majority of AOSPD patients were male (66, 80.5%), with a median age of 60 years. CP was present in 60 patients (73.2%), while 18 (22.0%) had pancreatic tumors. Pancreatic juice cultures were positive in 47 patients (90.4%). Key treatments included endoscopic pancreatic stenting (44, 53.7%) and endoscopic nasopancreatic drainage (31, 37.8%). All follow-up patients showed clinical improvement. Compared to acute-on-CP, AOSPD with CP was more prevalent in older males with a history of pancreaticobiliary intervention, alcohol consumption, and smoking. AOSPD with CP patients typically presented with fever, elevated white blood cell counts, increased C-reactive protein levels, pancreatic stones, and dilated pancreatic ducts. Interestingly, a lower proportion of AOSPD with CP patients exhibited elevated serum amylase levels (p < 0.05). AOSPD primarily affects middle-aged and elderly males with chronic pancreatic disease and prior pancreaticobiliary intervention. Imaging and pancreatic juice culture aid diagnosis. Compared to acute-on-CP, AOSPD with CP displays distinct clinical characteristics. Timely and accurate diagnosis and treatment can lead to favorable short-term outcomes for patients with AOSPD. [Display omitted]