Pancreatic syphilis

Syphilis of the pancreas can be congenital and acquired. It is believed that specific damage to the pancreas is found in almost 10-20% of children suffering from congenital syphilis; the head of the pancreas is most often affected. Syphilitic changes in the pancreas are detected in the fetus already in the second half of pregnancy.

Congenital syphilis of the pancreas

In congenital syphilis, in addition to the frequently occurring lesions of the pancreas, changes in the liver are characteristic - "flint liver", and also a number of other organs. The pancreas is usually enlarged and thickened, compacted, on sections - smooth, less often granular. Histological examination reveals proliferation of connective tissue containing a large number of round and spindle-shaped cells, often small gummas, as well as a greater or lesser number of pale treponemas. In particularly severe cases, due to pronounced sclerosis, atrophy of the pancreatic tissue (acini, ducts, pancreatic islets are affected to a lesser extent); sometimes with congenital syphilis, not only small, miliary, but also relatively large single solitary gummas are found. Thus, the morphological picture of congenital syphilis of the pancreas is variable, but most often the following three forms are distinguished:

1. diffuse interstitial (sometimes combined with the presence of miliary gummas);
2. gummatous;
3. occurring with predominant damage to the pancreatic ducts (sialangitis pancreatica).

In all cases, atrophy of glandular elements and proliferation of connective tissue with the development of pancreatic sclerosis are observed.

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Symptoms of congenital syphilis of the pancreas

Symptoms of congenital syphilis do not always manifest in the first weeks and months of a child's life with characteristic neurological disorders, skin rashes, anorexia, dystrophy, hepatosplenic syndrome and other manifestations characteristic of this disease. But in some cases, the main signs of the disease appear much later - in adolescence, youth and even 20-30 years or more after birth.

Diagnosis of congenital syphilis of the pancreas

To establish a diagnosis at this age, the characteristic Hutchinson's triad (keratitis, well-known dental changes, labyrinthine deafness) is important, as well as the deformation of the nose ("saddle" nose), "saber" shins. Of great importance is the detection of this disease in close relatives (father, mother, brothers, sisters), and finally, serological reactions, which at this age, unfortunately, are positive only in about 80% of patients, but RIBT and RIF (immobilization reactions of pale treponemas) - in almost 100% of cases. However, in order to perform these reactions, it is necessary to suspect this disease on the basis of the above signs or on the basis of positive serological reactions performed in the course of a medical examination, or during an examination of the patient (often for a completely different reason) in a hospital. Hepatosplenic syndrome, dyspeptic disorders, diarrhea, weight loss, signs of chronic pancreatitis in combination with diabetes mellitus at a relatively young age allow us to suspect damage to the pancreas in this disease. In this case, ultrasound reveals characteristic changes in the liver, and the pancreas is enlarged, compacted, sometimes focal formations (gummas) are found in it, which sometimes have to be differentiated from tumor nodes. It should be noted that manifestations of damage to the pancreas are relatively rare and occupy a leading place in the complex polysymptomatic picture of this disease.

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Treatment of congenital syphilis of the pancreas

Treatment of congenital syphilis of the pancreas is carried out by a venereologist, in addition, a gentle diet is prescribed, as in chronic pancreatitis, pancreatic enzyme preparations, in combination with liver damage - appropriate treatment. In case of endocrine pancreatic insufficiency - additional treatment, as in diabetes mellitus.

Acquired syphilis of the pancreas

Acquired syphilis of the pancreas is relatively rare. It was first described by K. Rokitansky (1861), who observed specific gummatous pancreatitis. Unfortunately, in recent years the incidence of syphilis has increased, which means that syphilis of the pancreas, both acquired and congenital, will be detected more often. The morphological picture of acquired syphilis of the pancreas is observed in three variants:

1. edematous-infiltrative form (in secondary syphilis);
2. gummatous form;
3. specific sclerotic pancreatitis.

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Symptoms of acquired syphilis of the pancreas

The clinical picture is variable: there are asymptomatic forms, as well as cases with clinical features of chronic pancreatitis, pancreatic tumor, and diabetes mellitus. Common symptoms include pain in the epigastric region and left hypochondrium, flatulence, diarrhea, and weight loss. Diabetes mellitus often occurs with the sclerotic form of syphilis of the pancreas. With the pseudotumor form, in addition to the characteristic symptoms - persistent pain and dyspeptic symptoms, in some cases it is possible to palpate a tumor-like formation in the area of the usual location of the pancreas. When the head of the pancreas is affected due to compression of the terminal part of the common bile duct by the infiltrate, mechanical jaundice may occur, which further simulates the clinical picture of a malignant tumor of the pancreas.

Diagnosis of acquired syphilis of the pancreas

Syphilitic damage to the pancreas can be suspected if signs of pancreatitis or diabetes mellitus are detected against the background of other manifestations of syphilis. According to N. I. Leporsky (1951), a clear sign is the disappearance of diabetes during antisyphilitic therapy, while conventional treatment of diabetes mellitus is ineffective. Anamnesis does not always help in establishing the etiology of the disease. The results of serological studies are of great importance. Ultrasound and scanning allow us to establish the presence of diffuse sclerotic or focal damage to the pancreas. In the most difficult cases for differential diagnosis, CT is used. A positive effect from specific treatment (functional tests improve, foci of inflammatory infiltration and even gumma resolve) finally confirms the syphilitic nature of the pancreatic damage.

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Treatment of acquired syphilis of the pancreas

Treatment of acquired syphilis of the pancreas is specific, antisyphilitic. In case of exocrine pancreatic insufficiency, enzyme preparations (pancreatin, panzinorm, festal, etc.) are additionally prescribed; in case of endocrine insufficiency, therapy is carried out according to the principles of treating diabetes mellitus.