The incidence of main pancreatic duct disruption in severe biliary pancreatitis

• Published in: The American journal of surgery 1998-07, Vol.176 (1), p.49-52
• Main Authors: Uomo, Generoso, Molino, Domenico, Visconti, Mario, Ragozzino, Alfonso, Manes, Gianpiero, Rabitti, Pier Giorgio
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Bile ducts; Biliary tract; Biological and medical sciences; Calculi; Cholangiopancreatography, Endoscopic Retrograde; Cysts; Disruption; Endoscopy; Female; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Incidence; Indication; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical imaging; Medical sciences; Middle Aged; Mortality; Necrosis; Other diseases. Semiology; Pancreas; Pancreatic Ducts - diagnostic imaging; Pancreatic Ducts - surgery; Pancreatitis; Pancreatitis, Acute Necrotizing - diagnostic imaging; Pancreatitis, Acute Necrotizing - epidemiology; Pancreatitis, Acute Necrotizing - surgery; Pancreatography; Prognosis; Prospective Studies; Surgery; Ultrasonic imaging
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/S0002-9610(98)00097-X

Background: Little is known regarding the incidence of main pancreatic duct disruption in patients suffering from acute necrotizing pancreatitis and whether the occurrence of this disruption may contribute to the decision to intervene surgically. The aim of this prospective study was to assess these findings in a group of patients with acute necrotizing biliary pancreatitis. Patients and Methods: Seventy-five consecutive patients with necrotizing acute pancreatitis and suspected biliary etiology underwent endoscopic retrograde cholangiopancreatography within the first week upon admission. Biliary pancreatitis (common bile duct stones or endoscopic features probative for recent transpapillary stone migration in patients with gallstones) was confirmed in 70 patients. Imaging not only of the biliary tract but also of the pancreatic ducts was pursued. Fifty-one patients (72.8%) were conservatively treated, 19 (27.1%) underwent surgery: indication for surgery was infection of necrosis in 15 cases, pseudocysts in 3 cases, and fistula in 1 case. Results: Satisfactory visualization of the main pancreatic duct was achieved in 59 cases (84.3%). Disruption of the main pancreatic duct was observed in 18 cases (30.5%), ie, 5 of the 17 patients who underwent surgery and 13 of the 42 patients who were nonoperatively managed (NS). Conclusions: Our results suggest that the loss of integrity of the main pancreatic duct, as verified with endoscopic pancreatography, constitutes quite a frequent event in acute biliary pancreatitis, and it should not be considered as an absolute indication for surgery in patients with sterile necrosis. Most of these patients can be safely managed without surgery.