ACUTE BILIARY PANCREATITIS - SPHINCTER OF ODDI AND CHOLEDOCHAL PRESSURE

Twenty four patients with biliary pancreatitis were divided into three groups: A (18 subjects underwent surgery on the biliary tract seven d ays after admission to hospital when acute signs disappeared); B (3 ca ses were operated two months later), and C (3 patients underwent emerg ency surgery for acute cholecistitis with simultaneous acute pancreati tis). A cholecistectomy-choledochostomy through a Kehr tube was perfor med in all patients. Pressure in the main biliary duct (MBD) was measu red. Only group A was significant (18 cases). As a control, another gr oup. group D was considered (52 biliary cholecysto-choledochal lithias is patients without pancreatitis and without transduodenal sphincterot omy). Group A: 1) The mean pressure in MBD on the fourth postoperative day (11 days after onset of pancreatitis) was low (p < 0.0001) in rel ation to that of group D with Oddi's sphincter (SO) normal; 2) in grou p A, no significant differences (p-NS) were found in relation to posit ions: during fasting, 4.4 +/- 4 cm H2O in the upright position, and 5. 3 +/- 2 when lying (in group D, 9.9 +/- 4.1 cm H2O upright, and 7.76 /- 3.6 lying with p = 0.0001), and 3) a slow improvement of pressure w as observed and, on the 25(th) day after operation, it was nearly norm al (9 cm H2O upright and 7 cm lying with p < 0.001). Group B: biliary surgery at 2 months; mean pressure in MBD meartly normal. Group C: 1) 4 days after emergency surgery, the pressure in MBF (15 cm H2O upright and 11.7 lying) was higher than in subjects with normal SO, probably due to compression of the distal part of MBD by the inflamed pancreas, and 2) from the 11(th) day the pressure followed the same evolution a s that of group A. In conclusion, in patients with acute biliary pancr eatitis, operated on the biliary tract when acute signs disappeared, M BD pressure is low (p < 0.0001) in reference to normal on the fourth p ost-operatory day (11 days after onset of pancreatitis) and no signifi cant differences were found in relation to positions (upright and lyin g). The pressure changes are transient (4-5 weeks) and most probably d ue to the lesions and malfunction of the SO related to pancreatitis.