Patency of the Santorini duct and acute biliary pancreatitis. A prospective ERCP study.
Disturbance of outflow of the pancreatic juice is considered to be a pathogenic factor in the development of acute biliary pancreatitis (ABP). In the years 1984-1988 sixty-seven patients admitted with ABP were prospectively allocated to urgent ERCP and endoscopic sphincterotomy. Diagnostic criteria of acute biliary pancreatitis were as follows: epigastric pain, an elevated serum amylase concentration, biochemical prediction of gallstones, positive pattern of pancreatitis in US and CT-scan and ERCP performed within 24 h of admission. At ERCP the anatomy of the pancreatic duct was evaluated and special attention was paid to the patency of the accessory (Santorini) duct as a potential outflow route of the pancreatic juice. The control group comprised 100 consecutive patients in whom a pancreatogram was obtained during ERCP performed because of expected biliary pathology. Patency of the Santorini duct was found merely in 17% patients with ABP. In contrast, this duct was patent in 69% of the patients in the control group (p less than 0.001). The absence of this additional possibility of draining pancreatic juice might be an important pathogenic factor in acute biliary pancreatitis.
Nowak
A
A
Department of Gastroenterology, Sil. Med. Academy, Katowice, Poland.
Nowakowska-Dutawa
E
E
Rybicka
J
J
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002769:Cholelithiasis / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010183:Pancreatic Ducts / Q000000981:diagnostic imaging*; D010195:Pancreatitis / Q000000981:diagnostic imaging* / Q000209:etiology; D011446:Prospective Studies