Chronic Pancreatitis

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Chronic pancreatitis with bile duct obstruction - Case Study:

52 year old lady with chronic pancreatitis was referred to us for management. She had history of severe acute pancreatitis 2 years back. It had led to a stricture in the neck of pancreas and resulted in chronic pancreatitis. When she approached us, she had a recent unsuccessful endoscopic attempt to remove stone in the pancreatic duct and stent insertion. The attempted ERCP however had caused damage in the form of an attack of acute pancreatitis and further increase in the inflammation around bile duct causing its narrowing.

We allowed the acute pancreatitis to settle over 4-5 days and then subjected her to surgery where in the pancreatic duct in body and tail was widely opened. The head of the pancreas was cored out relieving the inflammation around lower end of bile duct. Both pancreatic duct and head were joined to a loop of intestine by 2 separate anastomosis. The patient recovered well after surgery and was discharged in due course. She is now symptom free and eating well.

Bile duct obstruction is a complex problem in chronic pancreatitis and always raises possibility of beginning of cancer in those tissues. So we always try and rule out the malignancy and then subject patient to surgery. If patient has jaundice, a stent is placed in the bile duct. When bile duct stricture is very tight and duct is dilated, bile duct is joined to intestine at the time of pancreatic surgery. If cancer has set in, Whiple pancreatoduodenectomy is done.

We always have fear that overzealous endoscopy attempts to treat chronic pancreatitis can cause harm, delay in correct treatment, infection and increase in the cost of surgery. We are very careful and selective while recommending endotherapy in chronic pancreatitis.