Early morphological and functional changes in pancreas following necrosectomy for acute severe necrotizing pancreatitis.
BACKGROUND
Morphological and functional changes in the pancreas after surgical pancreatic necrosectomy have not been studied extensively.


OBJECTIVE
To study morphological changes in the pancreas, and exocrine and endocrine pancreatic function following pancreatic necrosectomy.


METHODS
Eighteen adult patients surviving at least one month after pancreatic necrosectomy for acute necrotizing pancreatitis were followed up. Contrast-enhanced computed tomography was done every six months. Stool fat was estimated at 3-month intervals, and need for and response to enzyme supplements were recorded. Blood sugar was measured every fortnight; in patients with hyperglycemia, need for oral hypoglycemic agents or insulin was recorded. Additional pancreatic imaging was done in some cases.


RESULTS
Six weeks after surgery, nine of 18 patients had exocrine insufficiency. Thirteen patients developed endocrine insufficiency, including 5 who also had exocrine insufficiency. At the end of the study, 13 patients had endocrine insufficiency and 2 had exocrine insufficiency. Pancreatic size was subnormal in all patients at the end of six months. Pancreatography in three cases did not reveal any ductal abnormality.


CONCLUSIONS
Necrotizing pancreatitis affects pancreatic exocrine or endocrine function in more than half the patients.
Bavare
Charudatta
C
Department of Surgical Gastroenterology, Seth G S Medical College and K E M Hospital, Mumbai 400 012, India.
Prabhu
Ramkrishna
R
Supe
Avinash
A
D000328:Adult; D006801:Humans; D007515:Islets of Langerhans / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000473:pathology / Q000503:physiopathology*; D046790:Pancreas, Exocrine / Q000503:physiopathology; D019283:Pancreatitis, Acute Necrotizing / Q000601:surgery*; D011184:Postoperative Period