A study of 50 cases in different modalities of treatment of chronic pancreatitis.

ABSTRACT

Background: Chronic pancreatitis was defined by features consistent with irreversible pancreatic inflammation, i.e., clinical, structural or functional abnormality of the pancreas. The presence of pancreatic calculi or ductal irregularity/parenchymal atrophy was determined at imaging using ultrasonography, CT scan, MRI, magnetic resonance cholangiopancreatography (MRCP), endoscopic retrograde cholangiopancreatography (ERCP) or endoscopic ultrasound (EUS). Material and methods: The profile of 50 patients with chronic pancreatitis seen in the Genral Surgery, Gastro surgery Department of Civil Hospital, Ahmedabad, from May 2007 to September 2009 were included. The diagnosis of chronic pancreatitis was based on clinical, biochemical (serumamylase, serum criteria and anti-diabtic treatment requirement) and imaging. Various treatment modalities like conservative, endotherapy and surgical were evaluated. Results: Out of 50 patients, 33 underwent surgery, 11 underwent endotherapy, 6 underwent external drainage via pigtail catheterization and 14 were kept on medical therapy that later on underwent surgery due to partial or no relief of abdominal pain. The indication for surgery was in these 33 patients and the surgical procedures were performed. 15 (10%) patients had postoperative complications; major among these being wound dehiscence (n=2), pancreatic fistula (n=1), gastrointestinal bleed (n=1) and intra abdominal bleed (n=1). There were four postoperative death (3 post whipple’s and 1 post triple bypass). Conclusion: Idiopathic pancreatitis is the most common form of chronic pancreatitis seen at our hospital, and in general, the majority of these subjects showed a good response to endotherapy and surgery of chronic pancreatitis. Pancreatic endotherapy is effective as short-term intervention, can be used at an early stage and has limited indications.