少见病因所致急性胰腺炎的临床特征分析：附4例报告并文献复习

Clinical features of acute pancreatitis caused by rare causes: a report of 4 cases and literature review

摘要:

背景与目的 急性胰腺炎（AP）是一种由多种因素引起的胰腺急性炎症反应，以胰酶异常激活及自身消化为主要特征。尽管常见病因为胆石症、高脂血症及饮酒，但部分患者的病因罕见且诊断延迟，易导致复发及误治。本文通过分析4例以AP为首发症状的少见病因病例，并结合文献复习，总结其诊断思路与治疗经验，为临床鉴别诊治提供参考。方法 回顾性分析中南大学湘雅三医院2021年11月—2024年9月收治的4例以AP为首发表现的少见病因患者的临床资料，结合国内外相关文献，探讨其病因特征、诊断要点及治疗策略。结果 4例患者的病因为胰腺导管内乳头状黏液性肿瘤、胰腺神经内分泌瘤、胰腺癌及十二指肠肠套叠。所有病例初诊时均表现为不明原因AP。经系统评估后，3例患者接受手术根治，术后恢复良好；1例患者因胰腺癌确诊较晚，仅行姑息性治疗，3个月后死亡。结论 少见病因所致的AP临床表现与常见类型相似，早期识别难度大。针对反复发作或原因不明的AP，应重视病因追溯，充分利用影像学及内镜检查手段明确诊断。对可手术病变应积极干预，以减少复发并改善预后。

Abstract:

Background and Aims Acute pancreatitis (AP) is an acute inflammatory disease of the pancreas caused by abnormal activation of pancreatic enzymes. Although gallstones, hyperlipidemia, and alcohol use are the most common causes, a subset of patients develop AP secondary to rare etiologies that are often misdiagnosed or diagnosed late, leading to recurrence or inappropriate management. This study aims to summarize the clinical characteristics, diagnostic strategies, and treatment outcomes of four cases of AP caused by uncommon etiologies, supported by a literature review.Methods Clinical data of 4 patients admitted to the Department of Hepatobiliary and Pancreatic Surgery, the Third Xiangya Hospital of Central South University, between November 2021 and September 2024, were retrospectively analyzed. Their etiological characteristics, diagnostic approaches, and treatment strategies were reviewed in combination with relevant literature.Results The underlying causes of AP were intraductal papillary mucinous neoplasm, pancreatic neuroendocrine tumor, pancreatic ductal adenocarcinoma, and duodenojejunal intussusception. All cases initially presented as idiopathic AP. Three patients underwent definitive surgical treatment and recovered well, while one patient with pancreatic cancer received only palliative care due to delayed diagnosis and died three months later.Conclusion AP secondary to rare etiologies often mimics common forms in clinical presentation but poses diagnostic challenges. For patients with recurrent or idiopathic AP, clinicians should emphasize etiological tracing and utilize advanced imaging and endoscopic modalities for early identification. Timely etiological intervention, particularly surgical management when appropriate, is essential for preventing recurrence and improving prognosis.