Solid-Pseudopapillärer Pankreastumor als sonographisches Inzidentalom bei akuter phlegmonöser Appendizitis

Zusammenfassung

Kasus: ♀ 21 J, Vorstellung wegen akuter phlegmonöser Appendizitis mit akutem Unterbauchschmerz und Übelkeit. Gleiche Symptomatik seit einem Jahr, allmonatlich rekurrierend, mit Spontanremission nach 2-4 Tagen. Erhöhung der Entzündungsparameter, Kokardenphänomen in der Sonographie. Nebenbefundlich, sonographisch: ca. 6 cm im Durchmesser fassender Tumor, im CT als zystisch-solide Raumforderung imponierend. OP: 1. laparoskopisch beginnend, Umstieg auf offene Appendektomie bei intraoperativ eitrig-phlegmonösem Bild. 2. Pankreaslinksresektion mit Splenektomie im Intervall (10. postoperativer Tag). Histologie: Solid-Pseudopapillärer Pankreastumor. Postoperativer Verlauf komplikationslos. - Vier Jahre nach Operation befindet sich die Patientin beschwerdefrei, bei physiologischer exo- und endokriner Pankreasfunktion. Schlussfolgerung: Auch bei eindeutigem sonographischem Befund, z. B. i. R. e. akuten Appendizitis mit Kokardenphänomen, freier intraabdomineller Flüssigkeit etc., sollte das gesamte Abdomen im Hinblick auf weitere auffällige Befunde sorgfältig evaluiert werden. Rekurrente Abdominalbeschwerden bedürfen der diagnostisch abklärenden Aufmerksamkeit.

Abstract

Objective: Review of the literature (Medline) based on a clinical case. Case: A twenty one year old lady presented with a one day history of acute right sided lower abdominal pain associated with leucocytosis and the clinical signs of an acute abdomen. Sonography showed fluid coincident with cocardal formation in the right lower abdomen. Incidentally a cystic formation in projection to the caudal pancreas was seen. A CT scan confirmed a cystic mass, 5 cm in diameter. An appendectomy was performed immediately after admission. After an interval of ten days an upper laparotomy leading to a left sided resection of the pancreas was performed. Histological findings showed a solid-pseudo-papillary tumor of the pancreas without any signs of metastatic spreading. Four years after the operation the patient is subjectively well and shows no signs of diabetes or of insufficiency of the exocrine pancreas nor of any recurrence. - Characteristic findings in solid-pseudo-papillary pancreatic tumors (SPPT) are remarkable size at the time of diagnosis, low risk of malignancy, predominance in young female (10 ♀ : 1 ♂, M = 27 a), association with oral anticonceptive drugs and mostly incidentally detection. Usually the definitive diagnosis is only found after complete radical resection which in 95 % of cases is curative. Conclusion: Abdominal sonography should be performed very thoroughly in any diagnostic query even if, clinically, the diagnosis seems to be obvious.

Schlüsselwörter

solid-pseudopapillärer Pankreastumor (SPPT) - akutes Abdomen - akute Appendizitis - Inzidentalom

Key words

solid-pseudo-papillary pancreatic tumor (SPPT) - incidentaloma - acute abdomen - acute appendicitis

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