scholarly journals Chronic pancreatitis with ductal stones in the pancreatic head treated by surgery: a case report

2020 ◽  
Vol 2020 (10) ◽  
Author(s):  
Alberto Meyer ◽  
Andreas Johann Molnar Koszka ◽  
Phillipe Abreu ◽  
Raphaella Ferreira ◽  
Marcelo Callado Fantauzzi ◽  
...  
Keyword(s):  
Chronic Pancreatitis ◽  
Pancreatic Duct ◽  
Pancreatic Head ◽  
Disease Process ◽  
Treatment Method ◽  
Appropriate Treatment ◽  
Feasible Option ◽  
Head Of The Pancreas ◽  
Pancreatic Duct Stones ◽  
Upper Abdominal

Abstract Pancreatic duct stones are direct sequelae of chronic pancreatitis (CP) and can occur in ∼50% of patients. Selection of the appropriate treatment method for pancreatic duct stones depends on location, size and number of stones. We present a patient with upper abdominal pain and weight loss for the previous 3 months. Diagnostic workup detected a chronic inflammation of the pancreas with stone in the main pancreatic duct and a nodular lesion in the head of the pancreas. Endoscopic retrograde cholangiopancreatography was performed without success. Given the rise in incidence and prevalence of CP, the potential complications and high mortality rate, it is imperative that physicians understand the risk factors, disease process and management of this disease. Pancreaticoduodenectomy in patients with CP is a feasible option for the treatment of focal cystic lesions to the head of the pancreas associated to pancreatic stone in selected cases.

scholarly journals The substantiation of chronic pancreatitis surgical treatment method selection

2007 ◽  
Vol 6 (3) ◽  
pp. 43-50
Author(s):  
V. A. Koubyshkin ◽  
I. A. Kozlov ◽  
N. I. Yashina ◽  
T. V. Shevchenko
Keyword(s):  
Chronic Pancreatitis ◽  
Surgical Treatment ◽  
Gastric Resection ◽  
Clinical Manifestations ◽  
Pancreatic Head ◽  
Pain Syndrome ◽  
Treatment Method ◽  
Pancreas Head ◽  
Resection Of The Pancreas

The experience of surgical treatment of 154 patients having chronic pancreatitis with preferential injury of the pancreas head which underwent different operative interventions: isolated resection of pancreatic head ( based upon Berger surgery - 24, Frey surgery - 39), pancreatoduodenal resection ( with gastric resection - 22, with preserved pylorus - 43) and drainage surgeries - 26 is presented in the article. The surgery of isolated resection of pancreatic head has less number of nearest unfavorable results compared with pancretoduodenal resection with preserved pylorus. Proximal resection of the pancreas the variants of which are different isolated resection of pancreatic head is superior upon surgeries with full or partly resection of the duodenum due to fast normalization of the motor-evacuation function, less rate of the intestinal reflux and portion character of duodenal evacuation. In the follow-up period after pancreatoduodenal resection, atrophic processes occur in distal areas of the pancreas which are followed by clinical manifestations of exo- and endocrinous insufficiency. The surgery of longitudinal pancreatic jejunostomy does not avoid pathologic changes in the organ head and pain syndrome.

ESWL treatment of pancreatic duct stones in symptomatic chronic pancreatitis

1998 ◽  
Vol 114 ◽  
pp. A467
Author(s):  
S Hansen ◽  
B Brand ◽  
VC Nam ◽  
KF Binmoeller ◽  
U Seitz ◽  
...  
Keyword(s):  
Chronic Pancreatitis ◽  
Pancreatic Duct ◽  
Pancreatic Duct Stones

scholarly journals Terlipressin as the element of medicamentous technique redicing blood loss in proximal ­resection of pancreatic head in a patient with extrahepatic form of portal hypertension as the outcome of chronic pancreatitis

2020 ◽  
Vol 101 (1) ◽  
pp. 102-106
Author(s):  
E A Borodenko ◽  
A D Gureev ◽  
I V Kolesnik ◽  
I G Trukhanova
Keyword(s):  
Chronic Pancreatitis ◽  
Portal Hypertension ◽  
Blood Loss ◽  
Pancreatic Head ◽  
Portal System ◽  
Synthetic Analogue ◽  
Surgical Methods ◽  
Portal Cavernoma ◽  
Long Acting ◽  
Upper Abdominal

The article presents a case of the use of medicamentous technique redicing blood loss with terlipressin a long-acting synthetic analogue of antidiuretic hormone. This pharmaceutical drug causes constrictin of arterioles, veins and venules, which leads to the reduction of blood flow in the visceral organs and pressure reduction in the portal system. In our federal institution of healthcare, a patient with chronic pancreatitis complicated by segmentary portal hypertension and portal cavernoma underwent proximal resection of pancreatic head by C.Fray, placing of a longitudinal pancreatojejunoanastomosis and azigoportal disconnection. The description of this case is aimed at drawing attention to relatively new and developing methods of medicamentous technique redicing blood loss, which in combination with surgical methods allows reducing perioperative blood loss in upper abdominal surgeries.

scholarly journals Criteria for the Selection of Diagnostic Signs of Chronic Pancreatitis with Obstruction of the Main Pancreatic Duct

2020 ◽  
Vol 13 (2) ◽  
pp. 76-85
Author(s):  
Alexander R Propp ◽  
Evgeny Nikolaevich Degovtsov
Keyword(s):  
Chronic Pancreatitis ◽  
Pancreatic Duct ◽  
Main Pancreatic Duct ◽  
Structural Changes ◽  
Early Stage ◽  
Pancreatic Head ◽  
Diagnostic Methods ◽  
Entire Length ◽  
Diagnostic Signs ◽  
Selection Of

Introduction. Clinical outcomes of surgery for patients with chronic pancreatitis (CP), considering low rates of 10-year survival, are often unsatisfying for surgeons. Due to the absence of common diagnostic criteria, especially at an early stage of the disease, patients of young and working age undergo surgery at different periods and with different methods. The development of optimal criteria for the selection of diagnostic signs of chronic pancreatitis will improve treatment outcomes.The aim of the study is 1) to perform a comparative assessment of the informative value of methods that specify diagnostics of CP with obstruction of the main pancreatic duct; 2) to develop criteria for the selection of diagnostic signs to highlight the main types of structural changes in the pancreas in chronic pancreatitis with obstruction of the main pancreatic duct.Materials and methods. The study included radiological findings of 231 patients with CP with obstruction of the main pancreatic duct operated from 1996 to 2018 in Omsk regional surgical hospital. X-ray investigations were performed in 120 patients, ultrasound investigations were performed in 231 patients, multislice spiral computed tomography (MSCT) was performed in 226 patients, MRI was performed in 18 patients, endoscopic retrograde cholangiopancreatography (ERCP) was performed in 22 patients and angiography was performed in 5 patients. All patients were divided into two groups: control (n ​​= 88, until 2008) and case (n = 143, after 2008), where new methods of surgery were used and the structure of the applied diagnostic methods has been changed.Results. Ultrasound sensitivity was 74.5%, fistulography/virsungography sensitivity was 80%, MSCT sensitivity was 97.8%, MRI sensitivity was 88.9% and ERPC sensitivity was 95.5%. The use of invasive diagnostic methods in the main group of patients was minimized with the priority of MSCT. The main criteria for the selection of diagnostic signs of CP were determined as follows: obstruction of the main pancreatic duct (with localization at the level of the pancreatic head exclusively or along its entire length), dilatation of the main pancreatic duct (more than 3 mm), local damage to the pancreatic head with an increase in its size over 32 mm, cystic formations (more than 5 mm) in the projection of any part of the pancreas. The main types of structural changes in the pancreas were identified as follows: 1. CP with obstruction of the main pancreatic duct at the level of the pancreatic head exclusively; 2. CP with obstruction of the main pancreatic duct along its entire length with an increase in the size of the pancreatic head; 3. CP with obstruction of the main pancreatic duct along its entire length without an increase in the size of the pancreatic head.Conclusion. 1) MSCT has the highest sensitivity in CP diagnostics (98.6%). MRI (Magnetic Resonance Cholangiopancreatography (MRCP)) complements MSCT and replaces it in case of patients intolerance to contrast media. Indications for ERCP should be minimized. 2) The designed criteria for the selection of diagnostic signs of CP will optimize diagnostics of chronic pancreatitis with obstruction of the main pancreatic duct and highlight the main types of structural changes in the pancreas, the fact being important for validation of surgical treatment methods and techniques.

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