Panikulitis pankreasa udružen sa periampularnim divertikulumom duodenuma

  • Tanja Tirnanić Military Medical Academy, *Clinic for Dermatovenerology, Belgrade, Serbia; University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia
  • Tatjana Radević Military Medical Academy, Clinic for Dermatovenerology, Belgrade, Serbia; University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia
  • Andrea Djordjević Military Medical Academy, Clinic for Dermatovenerology, Belgrade, Serbia; University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia
  • Nenad Petrov University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia; Military Medical Academy Institute of Pathology and Forensic Medicine, Belgrade, Serbia
  • Željko Mijušković Military Medical Academy, Clinic for Dermatovenerology Belgrade, Serbia; University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia
DOI: https://doi.org/10.2298/VSP230626043T
Ključne reči: dijagnoza, divertikulum, endoskopija, gastrointestinalna, histološke tehnike, pankreatin, pankreatitis, panikulitis, tomografija, kompjuterizovana, rendgenska

Sažetak


 

Uvod. Panikulitis pankreasa (PP) je retka forma lobularnog panikulitisa koja se manifestuje pojavom eritematoznih bolnih nodusa na koži predominantno donjih ekstremiteta.  U osnovi ovog oboljenja je supkutana masna nekroza uzrokovana oslobađanjem pankreasnih enzima koja se viđa kod 2–3% bolesnika sa bolestima pankreasa. Prikaz bolesnika. Prikazujemo 58-godišnjeg bolesnika koji je primljen u našu kliniku zbog pojave bolnih, eritematoznih nodusa na koži donjih ekstremiteta i trupa. Laboratorijske analize pokazale su povišene vrednosti pankreasnih enzima, amilaze i lipaze, povišene vrednosti glukoze i markera zapaljenja. Histopatološkom analizom bioptirane lezije kože pokazano je prisustvo pretežno lobularnog panikulitisa u hipodermu, sa poljima nekroze/saponifikacije masnog tkiva i ostacima adipocita („ćelijama-duhovima“). Kompjuterizovanom tomografijom abdomena utvrđeno je postojanje periampularnog divertikuluma (PD) duodenuma, bez znakova pankreatitisa ili drugih abnormalnosti pankreasa. Ezofagogastroduodenoskopijom viđen je širok otvor PD u D2 segmentu duodenuma. Bolesnik je uspešno lečen pankreatinom i došlo je do početne regresije promena na koži, uz sniženje nivoa pankreasnih enzima. Zaključak. Duodenalni PD mogu biti uzročnici PP, najverovatnije zbog pritiska koji vrše na izvodni kanal pankreasa, što može dovesti do povišenih vrednosti pankreasnih enzima. U zavisnosti od individualnih karakteristika bolesnika, terapija PD može biti hirurška i nehirurška. Lečenje PP podrazumeva lečenje oboljenja i stanja koja se nalaze u njegovoj osnovi.

 

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Objavljeno
2024/01/30
Broj časopisa
Vol. 81 Br. 01 (2024): Vojnosanitetski pregled
Rubrika
Prikaz bolesnika