Persistent acute pancreatitis. A variant treated by pancreatoduodenectomy
P. L. Rutledge and A. L. Warshaw
Surgical Services, Massachusetts General Hospital, Boston 02114.
Acute pancreatitis usually subsides spontaneously or is complicated by
pseudocysts, pancreatic necrosis, or abscesses. We describe an uncommon
variant of acute pancreatitis in which signs of inflammation persist over a
number of months, waxing and waning but never disappearing. Neither
identifiable collections nor other targets for surgical drainage develop in
these patients, nor does their condition ever remit enough to allow them to
leave the hospital. Eating provokes a flareup of inflammation. We have
treated five such patients with a pancreatoduodenectomy (four patients) or
total pancreatectomy (one patient). Each patient had been continuously
hospitalized for six to 12 weeks before operation. All survived the
operation and left the hospital eating solid food within 16 days. In
addition to acute inflammation and fat necrosis, the resected specimens
showed main pancreatic duct stenosis or occlusion in three patients, a
pancreaticoduodenal fistula in one, and a congenital duplication cyst.
Pancreatography or cholangiography showed the lesion in three of four cases
and helped in planning therapy. Thus, acute pancreatitis may fall to remit
because of proximal pancreatic duct obstruction, for which
pancreatoduodenectomy is a reasonable and effective treatment.