TITLE:
Contribution of Imaging in the Diagnosis and Management of Type 1 Autoimmune Pancreatitis Associated with Main Bile Duct Cholangitis: A Case Report
AUTHORS:
Keita Aboubacar Sidiki, Camara Mamoudou, Diallo Mamadou, Dembele Adama, Bah Ousmane Aminata, Cisse Mamadou
KEYWORDS:
Autoimmune Pancreatitis CT, MRI
JOURNAL NAME:
Case Reports in Clinical Medicine,
Vol.11 No.5,
May
27,
2022
ABSTRACT: Introduction: Autoimmune pancreatitis type 1 (AIP) is a rare condition characterized by inflammatory and fibrosing involvement of the pancreas, associated with elevated serum IgG4 and potential involvement of other organs. It often mimics a malignant tumor with which the differential diagnosis is often difficult. Observation: We report a case of AIP type 1, in a 70-year-old patient, with a heavy history of arterial hypertension, insulin-induced type II diabetes, overweight, gastric ulcer, ischemic heart disease with triple bypass, COPD, revealed by intense abdominal pain and acute evolution. The diagnosis was evoked on imaging, in front of an aspect of “sausage pancreas”, with delayed contrast enhancement of the pancreas, loss of lobulations, and the presence of a fibrous peripancreatic shell. The biological and histological assessment confirmed the diagnosis and avoided inappropriate surgical treatment. Conclusion: AIP type 1 is a rare pathology whose diagnosis is difficult. Only a perfectly interpreted imagery can evoke it. The biological assessment, in particular, the elevation of the serum level of IgG4 and the histology make it possible to confirm the diagnosis. The challenge in its management is to avoid unnecessary surgery and/or inappropriate treatments. Imaging, in this context, plays a preponderant role, in particular, thanks to the dynamic injection sequences of gadolinium chelates on MRI which suggest the fibro-inflammatory nature of pancreatic lesions.