THE INCIDENCE OF MAIN PANCREATIC DUCT DISRUPTION IN SEVERE BILIARY PANCREATITIS

BACKGROUND: Little is known regarding the incidence of main pancreatic duct disruption in patients suffering from acute necrotizing pancreat itis and whether the occurrence of this disruption may contribute to t he decision to intervene surgically. The aim of this prospective study was to assess these findings in a group of patients with acute necrot izing biliary pancreatitis. PATIENTS AND METHODS: Seventy-five consecu tive patients with necrotizing acute pancreatitis and suspected biliar y etiology underwent endoscopic retrograde cholangiopancreatography wi thin the first week upon admission, Biliary pancreatitis (common bile duct stones or endoscopic features probative for recent transpapillary stone migration in patients with gallstones) was confirmed in 70 pati ents, Imaging not only of the biliary tract but also of the pancreatic ducts was pursued. Fifty-one patients (72.8%) were conservatively tre ated, 19 (27.1%) underwent surgery: indication for surgery was infecti on of necrosis in 15 cases, pseudocysts in 3 cases, and fistula in 1 c ase. RESULTS: Satisfactory visualization of the main pancreatic duct w as achieved in 59 cases (84,3%). Disruption of the main pancreatic duc t was observed in 18 cases (30.5%), ie, 5 of the 17 patients who under went surgery and 13 of the 42 patients who were nonoperatively managed (NS). CONCLUSIONS: Our results suggest that the loss of integrity of the main pancreatic duct, as verified with endoscopic pancreatography, constitutes quite a frequent event in acute biliary pancreatitis, and it should not be considered as an absolute indication for surgery in patients with sterile necrosis. Most of these patients can be safely m anaged without surgery. (C) 1998 by Excerpta Medica, Inc.