Pancreatic duct strictures are a common cause of recurrent pancreatitis after successful management of pancreatic necrosis

Thomas Howard, Seth A. Moore, Romil Saxena, David E. Matthews, C. Schmidt, Eric A. Wiebke

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33 Citations (Scopus)

Abstract

Successful surgical management of pancreatic necrosis can result in structural changes that cause recurrent pancreatitis. The purpose of this study is to review our clinical experience managing recurrent pancreatitis in patients after successful pancreatic debridement. We retrospectively reviewed 98 patients with pancreatic necrosis treated by debridement who made a complete recovery at our institution over an 8-year period (January 1995 to January 2003). Fourteen patients (14%) developed recurrent pancreatitis 5 to 39 months (median, 15 months) after recovery. Five patients (36%) had pancreatic pseudocysts and 9 (64%) had radiologic evidence of obstructive pancreatitis. All patients had either a high-grade pancreatic duct stricture (N = 7) or complete duct cutoff (N = 7), localized to the pancreatic neck (N = 10) or proximal pancreatic body (N = 4) identified by either endoscopic retrograde cholangiopancreatography or magnetic resonance cholangiopancreatography. Two patients failed endoscopic stent therapy. All patients required re-operative treatment: 6 distal pancreatectomy, 6 pancreatico-jejunostomy Roux-en-Y, and 2 cystojejunostomy Roux-en-Y with no recurrence of pancreatitis after a median follow-up of 22 months. Recurrent pancreatitis occurs in 14% of patients after successful pancreatic debridement. Pancreatic duct obstruction in the neck or proximal body is the primary etiologic factor. Re-operation directed at alleviating this ductal obstruction by resection or drainage is effective.

Original languageEnglish
Pages (from-to)909-916
Number of pages8
JournalSurgery
Volume136
Issue number4
DOIs
StatePublished - Oct 2004

Fingerprint

Pancreatic Ducts
Pancreatitis
Pathologic Constriction
Necrosis
Debridement
Magnetic Resonance Cholangiopancreatography
Jejunostomy
Pancreatic Pseudocyst
Pancreatectomy
Endoscopic Retrograde Cholangiopancreatography
Stents
Drainage
Neck
Recurrence
Therapeutics

ASJC Scopus subject areas

  • Surgery

Cite this

Pancreatic duct strictures are a common cause of recurrent pancreatitis after successful management of pancreatic necrosis. / Howard, Thomas; Moore, Seth A.; Saxena, Romil; Matthews, David E.; Schmidt, C.; Wiebke, Eric A.

In: Surgery, Vol. 136, No. 4, 10.2004, p. 909-916.

Research output: Contribution to journalArticle

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