Absence of pancreatic duct dilation in chronic pancreatitis: surgical significance
C. Grodsinsky, B. M. Schuman and M. A. Block
Of 22 patients treated surgically for intractable pain from chronic
alcoholic pancreatitis, eight did not show notable dilation of the main
pancreatic duct by endoscopic retrograde cholangiopancreatography (ERCP),
operative pancreatography, and/or operative and microscopical studies of
the pancreas after subtotal pancreatectomy. In all patients, far advanced
parenchymal pancreatitis was evident at operation and by microscopical
study of the removed portion of the pancreas. These findings indicate that
the basic problem in a considerable number of patients with symptomatic
alcoholic chronic pancreatitis is not related primarily to obstruction with
dilation of the major pancreatic duct, but to intrinsic changes in the
parenchymal pancreas. The preoperative use of ERCP and individualization of
operative procedures with a preference for subtotal or partial
pancreatectomy for symptomatic chronic alcoholic pancreatitis are
supported.
