The term “acute pancreatitis” means “inflammation of the pancreas”, conceptually speaking.
This gland is transversely situated in the upper region of the abdomen, very near the posterior side of the stomach and pancreas, and segregates digestive enzymes to the duodenum through the pancreatic duct. These enzymes help in the digestion of fats, proteins and carbohydrates. Moreover, they supply hormones such as insulin or glucagon to the blood. The pancreatic enzymes proceed with their activity in the small bowel. Cases in which this activity begins in the very gland, a self-digestion of the gland occurs.
Acute pancreatitis appears suddenly, but after a medical treatment all the typical symptoms disappear: abdominal pain, nausea and vomits. However, its evolution is unpredictable in many cases. When the pancreatitis reaches a serious stage, we can find digestive hemorrhages and sepsis, sometimes respiratory and renal disorders and, in certain cases, even multiorganic disorder. Locally, the most frequent complications are the infection of the pancreatic tissue and necrotic peripancreatic tissue, formation of abscesses, vascular complications, hemorrhage due to arterial vessel erosion or adjacent vein thrombosis, or the formation of pancreatic pseudocysts. Very occasionally ascites or pancreatic pleural effusion can be found.
The most frequent cause of acute pancreatitis is cholelithiasis or choledocholithiasis, as well as alcohol abuse. Through analysis, diagnosis is given when high blood levels of amylase and lipase can be confirmed. Ultrasonography case study permits orientating the cause of the pancreatitis (cholelithiasis). A helical computed tomography scanning of the abdomen gives information of its seriousness (necrosis of the gland and the surrounding tissue, fluid collection, abscesses, etc). Finally, a cholangioresonance permits ruling out the presence of localized biliary tree calculi.
The medical treatment of acute pancreatitis needs serotherapy, a resting period of the digestive apparatus as well as the usual measures. Sometimes, it is necessary to extend this resting period for a few weeks. Therefore, the patient will need nutritional support. The definitive treatment requires extracting the calculi from the biliary tree or a cholecystectomy in case the pancreatitis is caused by cholelithiasis. Normally, this extraction is done through endoscopy (endoscopic retrograde cholangiopancreatography). Surgery is sometimes needed to treat the local pancreatic involvement when this cannot be done with interventionist radiology. If the inflammation of the gland develops complications, and a pseudocyst of the pancreas (which does not disappear on its own) appears, an inner drainage with endoscopy or laparoscopy to the stomach, duodenum or intestine will be necessary.
Chronic pancreatitis is the sign of a continuous aggression, mainly of alcohol, although we cannot dismiss ductal causes (tumors, calculi or anatomical deformities) that make drainage through the duct of Wirsung difficult. Other causes such as hereditary pancreatitis are very infrequent. Clinically, it becomes evident due to the presence of abdominal pain (sometimes difficult to control pharmacologically), weight loss, jaundice due to compression-obstruction of the extrahepatic biliary tree, pancreatic endocrine (diabetes) or exocrine (steatorrhea) failure.
The visualization of the pancreatic duct (resonance imaging of the pancreas and endoscopic retrograde cholangiopancreatography) and the confirmation of the gland damage as a whole, as well as the need to dismiss a related tumor (helical computed tomography of the abdomen, PET-CT scan and endoscopic ultrasonography) are essential diagnostic aspects that must be performed.
The main aim in patients with chronic pancreatitis is treating (ductal alterations) or stopping the reason for its existence (consumption of alcohol) in case there is one, as well as controlling the abdominal pain and improving all related malabsorptive problems.
It is not easy to prescribe surgery in patients with chronic pancreatitis. A group of medical professionals consider each case from a comprehensive perspective before prescribing this. Surgery is necessary if there is any doubt on the presence of a malignant tumor, an abdominal pain or malabsorptive syndrome that cannot be controlled clinically or in case of cholestasis. Moreover, surgery will be adapted to the patients’ characteristics and, most importantly, to the cause of the problem and damage suffered by the pancreas to the moment.
Our institution is well experimented in the most usual techniques for this indication : endoscopic or surgical sphincterotomy of the pancreatic sphincter with or without prosthesis for the duct, central pancreatectomy, cephalic pancreatectomy with conservation of the duodenum, cephalic duodenopancreatectomy with or without conservation of the pylorus, and total esplenoduodenopancreatectomy.