Misdiagnosis of intrapancreatic accessory spleen： A report of two cases / 临床肝胆病杂志

Accessory spleen refers to the spleen tissue that exists outside of the normal spleen， with a similar structure to the main spleen and certain functions. Intrapancreatic accessory spleen （IPAS） completely enveloped by the pancreas has an incidence rate of only 2%， and it is easily misdiagnosed in clinical practice due to its atypical clinical symptoms and similar radiological features to pancreatic neuroendocrine tumor， pancreatic solid pseudopapillary tumor， and other pancreatic space-occupying lesions. This article reports the clinical data of two patients with IPAS who were misdiagnosed as pancreatic neuroendocrine tumor and pancreatic solid pseudopapillary tumor， respectively， analyzes the reasons for misdiagnosis， and summarizes the experience in diagnosis and treatment， in order to improve the ability for the differential diagnosis of IPAS in clinical practice.

Association of nonalcoholic fatty liver disease with the severity of hyperlipidemic acute pancreatitis / 临床肝胆病杂志

ObjectiveTo investigate the association of nonalcoholic fatty liver disease (NAFLD) with the severity of hyperlipidemic acute pancreatitis (HLAP). MethodsA retrospective analysis was performed for 895 patients with acute pancreatitis (AP) who were admitted to Department of Pancreatic Surgery in Renmin Hospital of Wuhan University from February 20, 2018 to January 20, 2020, among whom 101 patients with HLAP were screened out. According to the presence or absence of NAFLD, the 101 patients with HLAP were divided into non-NAFLD group with 41 patients and NAFLD group with 60 patients. Related clinical data were collected, including general information (sex, age, body mass index, diabetes, and hypertension), biochemical parameters (amylase, lipase, alanine aminotransferase, aspartate aminotransferase, albumin, total bilirubin, blood urea, serum creatinine, blood glucose, blood sodium, blood calcium, cholesterol, triglyceride, lactate dehydrogenase, and high-sensitivity C-reactive protein), white blood cell count (WBC), severity of AP, local complications under CT scan, systemic inflammatory response syndrome, bacteremia, organ failure, hospitalization, and recurrence of HLAP ［length of hospital stay, rate of admission to the intensive care unit (ICU), 1-year recurrence rate of HLAP, and number of HLAP attacks within 1 year］. The independent samples t-test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test or the Fisher’s exact test was used for comparison of categorical data between two groups. ResultsCompared with the non-NAFLD group, the NAFLD group had significantly higher blood glucose and WBC and a significantly lower blood sodium level on admission (Z=-2.241, t=2.187, t=-2.533, all P＜0.05). Compared with the non-NAFLD group, the NAFLD group had a significantly higher proportion of patients with severe AP (750% vs 53.7%, χ2= 4.968, P＜0.05), as well as significantly higher incidence rates of local complications, systemic inflammatory response syndrome, bacteremia, and respiratory failure (χ2=6.059, 4.611, 4.056, and 4.568, all P＜0.05). There was no significant difference in length of hospital stay between the two groups (P＞0.05), and the NAFLD group had a significantly higher rate of admission to the ICU than the non-NAFLD group (23.3% vs 7.3%, χ2= 4.463, P＜0.05). In addition, there were no significant differences in 1-year recurrence rate of HLAP and number of HLAP attacks within 1 year between the two groups (both P＞005). ConclusionNAFLD is significantly associated with the severity of HLAP, and furthermore, NAFLD may play an important role in the early severity assessment, disease progression, and prognosis prediction of HLAP.