Syphilis of the pancreas

Syphilis of the pancreas can be congenital and acquired. It is believed that a specific lesion of the pancreas is found in almost 10-20% of children suffering from congenital syphilis; more often affects the head of the pancreas. Syphilitic changes in the pancreas are found in the fetus as early as the second half of pregnancy.

Congenital syphilis of the pancreas

In congenital syphilis, in addition to the often occurring lesions of the pancreas, the liver changes - "flint liver", and also a number of other organs. The pancreas is usually enlarged and thickened, compacted, on the cuts - smooth, less often granular. Histological examination determines the proliferation of connective tissue containing a large number of round and spindle-shaped cells, often - small gums, as well as more or less pale treponem. In severely severe cases, due to severe sclerosis, atrophy of pancreatic tissue (acini, ducts, pancreatic islets to a lesser extent) is determined; sometimes with congenital syphilis not only small, miliary, but also comparatively large size, single solitary gums are found. Thus, the morphological picture of congenital syphilis of the pancreas is variable, but most often distinguish between the following three forms:

1. diffuse interstitial (sometimes combined with the presence of miliary gumms);
2. gummy;
3. flowing with a predominant lesion of pancreatic ducts (sialangitis pancreatica).

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

[1], [2], [3], [4], [5],

Symptoms of congenital syphilis of the pancreas

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

Diagnosis of congenital syphilis of the pancreas

To establish the diagnosis at this age, the typical Hutchinson triad (keratitis, well-known dental changes, labyrinthine deafness), as well as deformation of the nose ("saddle" nose), "saber" shins, are important. Of great importance is the identification of this disease in the immediate family (father, mother, brothers, sisters) of this disease, and finally, serological reactions, which at this age, unfortunately, are only positive in about 80% of patients; however, RIBT and RIF (reactions of immobilization of pale treponem) - almost in 100% of cases. However, in order to fulfill 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 order of clinical examination, or when the patient is examined (often for a completely different matter) in the hospital. Hepatolyenal syndrome, dyspeptic disorders, diarrhea, weight loss, signs of chronic pancreatitis in combination with diabetes in a relatively young age can also suspected pancreatic disease in this disease. In this case, ultrasound reveals characteristic changes in the liver, and the pancreas is enlarged in size, compacted, sometimes focal formations (gums) are found in it, which sometimes have to be differentiated from tumor nodes. It should be noted that manifestations of the defeat of the pancreas relatively rarely occupy a leading place in the complex polysymptomatic picture of this disease.

[6], [7],

Treatment of congenital syphilis of the pancreas

Treatment of congenital syphilis of the pancreas is performed at the venereologist, in addition, a sparing diet is prescribed, as in chronic pancreatitis, preparations of pancreatic enzymes, when combined with liver damage, appropriate treatment. With incremental insufficiency of the pancreas - additional treatment, as in diabetes mellitus.

Acquired syphilis of the pancreas

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

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

[8], [9], [10]

Symptoms of acquired syphilis of the pancreas

The clinical picture is variable: there are both asymptomatic forms, and cases that occur with the clinic of chronic pancreatitis, pancreatic tumors, and diabetes mellitus. Frequent symptoms are pain in the epigastric region and the left hypochondrium, flatulence, diarrhea, weight loss. Diabetes often occurs with the sclerotic form of syphilis of the pancreas. In pseudo-tumoral form, in addition to the characteristic symptoms - persistent pains and dyspeptic phenomena, in some cases it is possible to propalpate the tumor-like formation in the region of the usual arrangement of the pancreas. When the head of the pancreas is damaged due to the infiltration of the terminal part of the common bile duct, mechanical jaundice may occur, which further simulates the clinical picture of the malignant tumor of the pancreas.

Diagnosis of acquired pancreatic syphilis

It is possible to suspect syphilitic damage of the pancreas if signs of pancreatitis or diabetes mellitus are found against the background of other manifestations of syphilis. The evidence, according to NI Leporskiy (1951), is the disappearance of the phenomena of diabetes during antisyphilitic therapy, while the usual treatment of diabetes mellitus is ineffective. The anamnesis does not always help in establishing the etiology of the disease. Very important are the results of serological studies. Ultrasound and scanning can establish the presence of diffuse sclerotic or focal pancreatic lesions. In the most difficult cases for differential diagnosis, CT is used. The positive effect of specific treatment (functional tests are improving, inflammatory infiltration foci and even gum are resolving) finally confirms the syphilitic nature of the pancreatic lesion.

[11], [12],

Treatment of acquired pancreatic syphilis

Treatment of acquired pancreatic syphilis is specific, antisyphilitic. With exocrine insufficiency of the pancreas, enzyme preparations (pancreatin, panzinorm, festal, etc.) are additionally prescribed, and for endocrine therapy, therapy is carried out according to the principles of treatment of diabetes mellitus.