title: Surgical approaches to chronic pancreatitis: indications and imaging findings.
abstract: Chronic pancreatitis (CP) is an irreversible, inflammatory process characterized by progressive fibrosis of the pancreas that can result in abdominal pain, exocrine insufficiency, and diabetes. Inadequate pain relief using medical and/or endoscopic therapies is an indication for surgery. The surgical management of CP is centered around three main operations including pancreaticoduodenectomy (PD), duodenum-preserving pancreatic head resection (DPPHR) and drainage procedures, and total pancreatectomy with islet autotransplantation (TPIAT). PD is the method of choice when there is a high suspicion for malignancy. Combined drainage and resection procedures are associated with pain relief, higher quality of life, and superior short-term and long-term survival in comparison with the PD. TPIAT is a reemerging treatment that may be promising in subjects with intractable pain and impaired quality of life. Imaging examinations have an extensive role in pre-operative and post-operative evaluation of CP patients. Pre-operative advanced imaging examinations including CT and MRI can detect hallmarks of CP such as calcifications, pancreatic duct dilatation, chronic pseudocysts, focal pancreatic enlargement, and biliary ductal dilatation. Post-operative findings may include periportal hepatic edema, pneumobilia, perivascular cuffing and mild pancreatic duct dilation. Imaging can also be useful in the detection of post-operative complications including obstructions, anastomotic leaks, and vascular lesions. Imaging helps identify unique post-operative findings associated with TPIAT and may aid in predicting viability and function of the transplanted islet cells. In this review, we explore surgical indications as well as pre-operative and post-operative imaging findings associated with surgical options that are typically performed for CP patients.
authors.affiliation: The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Johns Hopkins University, 601 North Caroline Street, JHOC 3235 A, Baltimore, MD, 21287, USA.
authors.forename: Nima
authors.initials: N
authors.lastname: Hafezi-Nejad
authors.affiliation: Pancreatitis Center, Johns Hopkins Medical Institutions, Baltimore, MD, USA.|Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
authors.forename: Vikesh K
authors.initials: VK
authors.lastname: Singh
authors.affiliation: The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Johns Hopkins University, 601 North Caroline Street, JHOC 3235 A, Baltimore, MD, 21287, USA.
authors.forename: Stephen I
authors.initials: SI
authors.lastname: Johnson
authors.affiliation: Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: Martin A
authors.initials: MA
authors.lastname: Makary
authors.affiliation: Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: Kenzo
authors.initials: K
authors.lastname: Hirose
authors.affiliation: The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Johns Hopkins University, 601 North Caroline Street, JHOC 3235 A, Baltimore, MD, 21287, USA.
authors.forename: Elliot K
authors.initials: EK
authors.lastname: Fishman
authors.affiliation: The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Johns Hopkins University, 601 North Caroline Street, JHOC 3235 A, Baltimore, MD, 21287, USA. azaheer1@jhmi.edu.|Pancreatitis Center, Johns Hopkins Medical Institutions, Baltimore, MD, USA. azaheer1@jhmi.edu.
authors.forename: Atif
authors.initials: A
authors.lastname: Zaheer
mesh_terms: D004322:Drainage; D006801:Humans; D059408:Pain Management; D010180:Pancreatectomy; D016577:Pancreaticoduodenectomy; D050500:Pancreatitis, Chronic / Q000000981:diagnostic imaging* / Q000601:surgery*; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D011788:Quality of Life
keywords: Chronic pancreatitis; Duodenum-preserving pancreatic head resection; Imaging; Islet autotransplantation; Pancreaticoduodenectomy; Total pancreatectomy