Pancreatic duct strictures are a common cause of recurrent pancreatitis after successful management of pancreatic necrosis.
BACKGROUND
Successful surgical management of pancreatic necrosis can result in structural changes that cause recurrent pancreatitis. The purpose of this study is to review our clinical experience managing recurrent pancreatitis in patients after successful pancreatic debridement.


METHODS
We retrospectively reviewed 98 patients with pancreatic necrosis treated by debridement who made a complete recovery at our institution over an 8-year period (January 1995 to January 2003).


RESULTS
Fourteen patients (14%) developed recurrent pancreatitis 5 to 39 months (median, 15 months) after recovery. Five patients (36%) had pancreatic pseudocysts and 9 (64%) had radiologic evidence of obstructive pancreatitis. All patients had either a high-grade pancreatic duct stricture (N=7) or complete duct cutoff (N=7), localized to the pancreatic neck (N=10) or proximal pancreatic body (N=4) identified by either endoscopic retrograde cholangiopancreatography or magnetic resonance cholangiopancreatography. Two patients failed endoscopic stent therapy. All patients required re-operative treatment: 6 distal pancreatectomy, 6 pancreatico-jejunostomy Roux-en-Y, and 2 cystojejunostomy Roux-en-Y with no recurrence of pancreatitis after a median follow-up of 22 months.


CONCLUSIONS
Recurrent pancreatitis occurs in 14% of patients after successful pancreatic debridement. Pancreatic duct obstruction in the neck or proximal body is the primary etiologic factor. Re-operation directed at alleviating this ductal obstruction by resection or drainage is effective.
Pancreas Research Group, Department of Surgery, Indiana University School of Medicine, Indianapolis 46202, USA.
Thomas J
TJ
Howard
Seth A
SA
Moore
Romil
R
Saxena
David E
DE
Matthews
Christian M
CM
Schmidt
Eric A
EA
Wiebke
D000328:Adult; D000368:Aged; D003251:Constriction, Pathologic / Q000209:etiology / Q000601:surgery; D003646:Debridement / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D010179:Pancreas / Q000473:pathology* / Q000601:surgery; D010182:Pancreatic Diseases / Q000209:etiology / Q000601:surgery; D010183:Pancreatic Ducts / Q000473:pathology*; D019283:Pancreatitis, Acute Necrotizing / Q000150:complications / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome