Duodenal lesions following severe acute pancreatitis: Review of 10 years' clinical experience

Background/Aims: Acute pancreatitis may result in many local and contiguous organ complications; though the pancreas is in close proximity to the duod enum anatomically, acute pancreatitis causing duodenal lesions is rarely en countered. Our aim is to retrospectively evaluate the clinical features of the duodenal lesions in patients with severe acute pancreatitis. Methodology: During the past 10 years, 1,637 consecutive patients with acut e pancreatitis were admitted to Taipei Veterans General Hospital. Total par enteral nutrition was employed in 251 patients with acute pancreatitis, def ined as 'severe acute pancreatitis'. They had all received computed tomogra phy during the hospitalization period, and the computed tomography reports were reviewed to find patients with duodenal involvement induced from pancr eatitis. We defined those patients having duodenal wall thickening, extrins ic compression of the duodenum, or other obstructive lesions seen on the co mputed tomography scan as evident duodenal lesion or duodenal involvement. Results: Nine cases of evident duodenal lesions following severe acute panc reatitis have been documented over a 10-year period in 1 teaching medical c enter. The lesions were found by image study or during operation. The most frequently involved site was the second portion of the duodenum. Clinically , 1 unique case developed severe duodenal obstruction requiring surgical co rrection, and 7 cases recovered after supportive therapy. Of the 9, only 1 case died of multiple organ failure. Conclusions: In contrast to the colonic lesions caused by acute pancreatiti s with a high morbidity and mortality, total parenteral nutrition yields a good prognosis in patients with evident duodenal lesions following severe a cute pancreatitis.