Acute pancreatitis due to Clonorchis sinensis

Abstract

In a series of 110 southern Chinese patients in Hong Kong, suffering from acute pancreatitis considered to be of undetermined etiology, 91 (83%) were found to be infected with C. sinensis. In view of the limitations of the methods of diagnosis employed the infection rate was probably higher. However, the established incidence is more than double that encountered in a random sample of the population. Further, the ratio of males to females in the series was 3:2, a ratio similar to that encountered in clonorchiasis but the reverse of that in most reported series of pancreatitis. Evidence is presented that the adult flukes reside not only in the bile ducts but also in the pancreatic ducts. Obstruction to these latter is produced by the presence of the flukes per se and by secondary changes in the walls of the ducts. These changes, which include metaplasia of the epithelium, are described briefly and illustrated and it is considered that they can only be attributed to the infection. In 75% of the patients the attack of pancreatitis followed 1-3 hr. after ameal, unusual in that the protein content of animal origin was greatly increased over the amount normally consumed. The evidence, in the light of present knowledge, suggests that, in the main, the pancreatitis was provoked by stimulation of the secretion of pancreatic juice by an unusual meal, in the presence of obstruction within the pancreatic ducts caused directly and indirectly by the presence of C. sinensis.