Chronic pancreatitis progressing from segmental lesions.
OBJECTIVE
Chronic pancreatitis is histologically and functionally a progressive disease. To examine the natural history of chronic pancreatitis, we evaluated serial pancreatography in cases of chronic pancreatitis, focusing on the progression of diffuse-type chronic pancreatitis from the segmental type.


METHODS
We reviewed 57 patients with chronic pancreatitis who had undergone endoscopic retrograde pancreatography on more than 2 occasions at intervals of at least 1 year. Cases of chronic pancreatitis were categorized as diffuse (n=37) and segmental (n=20) on the findings of initial endoscopic retrograde pancreatography.


RESULTS
Twenty-three cases of diffuse-type chronic pancreatitis showed progression of pancreatic duct abnormalities. Segmental abnormalities of the main pancreatic duct at the body or tail of the pancreas spread to the head of the pancreas in 8 cases. Etiologies of these cases of chronic pancreatitis were alcoholic, in which patients continued drinking after initial endoscopic retrograde pancreatography. In 2 patients who underwent distal pancreatectomy, although segmental lesions showed typical histological findings of alcoholic chronic pancreatitis, appearances near the margin of these lesions were almost normal or indicated slight interlobular fibrosis.


CONCLUSIONS
The pancreatic tail might represent the site of the initial lesion in some cases of alcoholic pancreatitis.
Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan. kamisawa@cick.jp
Terumi
T
Kamisawa
Masakatsu
M
Matsukawa
Masami
M
Yoshiike
Naoto
N
Egawa
Hitoshi
H
Nakajima
Kouji
K
Tsuruta
Atsutake
A
Okamoto
D000328:Adult; D000368:Aged; D002908:Chronic Disease; D018450:Disease Progression; D016145:Endoscopy, Digestive System; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology*; D011859:Radiography; D012189:Retrospective Studies; D012720:Severity of Illness Index