Diagnosis and treatment of duodenal dystrophy in patients with chronic pancreatitis

• Published in: Hirurgija (Moskva) no. 8; p. 25
• Main Authors: Kriger, A G, Smirnov, A V, Berelavichus, S V, Gorin, D S, Karmazanovskiy, G G, Vetsheva, N N, Nerestyuk, Ya I, Kalinin, D V, Glotov, A V
• Format: Journal Article
• Language: Russian
• Published: Russia (Federation) 2016
• Subjects: Adult; Duodenal Diseases - diagnosis; Duodenal Diseases - etiology; Duodenal Diseases - therapy; Duodenum - diagnostic imaging; Duodenum - pathology; Endosonography - methods; Female; Humans; Magnetic Resonance Imaging - methods; Male; Middle Aged; Pancreas - diagnostic imaging; Pancreas - pathology; Pancreaticoduodenectomy - methods; Pancreatitis, Chronic - complications; Pancreatitis, Chronic - diagnosis; Pancreatitis, Chronic - surgery; Retrospective Studies; Tomography, X-Ray Computed - methods; Treatment Outcome
• ISSN: 0023-1207
• DOI: 10.17116/hirurgia2016825-32

to define optimal treatment of duodenal dystrophy in patients with chronic pancreatitis. 515 patients with chronic pancreatitis have been treated for the period 2004-2015 in A.V.Vishnevsky Institute of Surgery. Duodenal dystrophy (DD) was diagnosed in 79 (15.3%) of them. The diagnosis was confirmed by sonography, CT, MRI and endosonography. 5 patients are under observation without surgery. 74 patients were operated after previous medical therapy during 39 months on the average. Pancreatoduodenectomy was performed in 36 patients. Organ-sparing interventions were applied in 34 cases including different duodenal resections in 20 patients and pancreatic head resections in different modifications in 14 cases. 4 patients underwent palliative surgery. Chronic pancreatitis and DD were verified by morphological analysis of specimens. Long-term results were estimated in 47 patients. Median follow-up was 49.9 months. X-ray diagnostics showed that DD was combined with chronic pancreatitis in 87.3% of cases while morphological analysis revealed 93.8%. Clinical signs of DD were caused by striated pancreatitis in 69.6% and ectopic pancreatic tissue in 30.4%. Clinical manifestations of DD did not depend on its cause and were presented by symptoms of chronic pancreatitis. Postoperative complications occurred in 25 (34.7%) patients. There were 33.5% of complications after pancreatoduodenectomy and 70% after duodenal resection. 1 patient died. Overall mortality was 1,3%. In long-term period complete regression of symptoms was observed in 66% of cases, significant improvement - in 32%, absence of the effect - in 2%. Medical therapy should be preferred for patients with DD and chronic pancreatitis. Surgery is indicated in case of persistent pain, complicated course of chronic pancreatitis and duodenal obstruction. Pancreatoduodenectomy and pancreatic head resection are preferred.