A Unifying Concept

Pancreatic Ductal Anatomy Both Predicts and Determines the Major Complications Resulting from Pancreatitis

William H. Nealon, Manoop Bhutani, Taylor S. Riall, Gottumukkala Raju, Orhan Ozkan, Ryan Neilan

    Research output: Contribution to journalArticle

    46 Citations (Scopus)

    Abstract

    Background: Precepts about acute pancreatitis, necrotizing pancreatitis, and pancreatic fluid collections or pseudocyst rarely include the impact of pancreatic ductal injuries on their natural course and outcomes. We previously examined and established a system to categorize ductal changes. We sought a unifying concept that may predict course and direct therapies in these complex patients. Study Design: We use our system categorizing ductal changes in pseudocyst of the pancreas and severe necrotizing pancreatitis (type I, normal duct; type II, duct stricture; type III, duct occlusion or "disconnected duct"; and type IV, chronic pancreatitis). From 1985 to 2006, a policy was implemented of routine imaging (cross-sectional, endoscopic retrograde cholangiopancreatography, or magnetic resonance cholangiopancreatography). Clinical outcomes were measured. Results: Among 563 patients with pseudocyst, 142 resolved spontaneously (87% of type I, 5% of type II, and no type III, and 3% of type IV). Percutaneous drainage was successful in 83% of type I, 49% of type II, and no type III or type IV. Among 174 patients with severe acute pancreatitis percutaneous drainage was successful in 64% of type I, 38% of type II, and no type III. Operative debridement was required in 39% of type I and 83% and 85% of types II and III, respectively. Persistent fistula after debridement occurred in 27%, 54%, and 85% of types I, II, and III ducts, respectively. Late complications correlated with duct injury. Conclusions: Pancreatic ductal changes predict spontaneous resolution, success of nonoperative measures, and direct therapies in pseudocyst. Ductal changes also predict patients with necrotizing pancreatitis who are most likely to have immediate and delayed complications.

    Original languageEnglish (US)
    Pages (from-to)790-799
    Number of pages10
    JournalJournal of the American College of Surgeons
    Volume208
    Issue number5
    DOIs
    StatePublished - May 2009

    Fingerprint

    Pancreatitis
    Anatomy
    Debridement
    Drainage
    Acute Necrotizing Pancreatitis
    Magnetic Resonance Cholangiopancreatography
    Endoscopic Retrograde Cholangiopancreatography
    Wounds and Injuries
    Chronic Pancreatitis
    Fistula
    Pancreas
    Pathologic Constriction
    Therapeutics

    ASJC Scopus subject areas

    • Surgery

    Cite this

    A Unifying Concept : Pancreatic Ductal Anatomy Both Predicts and Determines the Major Complications Resulting from Pancreatitis. / Nealon, William H.; Bhutani, Manoop; Riall, Taylor S.; Raju, Gottumukkala; Ozkan, Orhan; Neilan, Ryan.

    In: Journal of the American College of Surgeons, Vol. 208, No. 5, 05.2009, p. 790-799.

    Research output: Contribution to journalArticle

    Nealon, William H. ; Bhutani, Manoop ; Riall, Taylor S. ; Raju, Gottumukkala ; Ozkan, Orhan ; Neilan, Ryan. / A Unifying Concept : Pancreatic Ductal Anatomy Both Predicts and Determines the Major Complications Resulting from Pancreatitis. In: Journal of the American College of Surgeons. 2009 ; Vol. 208, No. 5. pp. 790-799.
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    abstract = "Background: Precepts about acute pancreatitis, necrotizing pancreatitis, and pancreatic fluid collections or pseudocyst rarely include the impact of pancreatic ductal injuries on their natural course and outcomes. We previously examined and established a system to categorize ductal changes. We sought a unifying concept that may predict course and direct therapies in these complex patients. Study Design: We use our system categorizing ductal changes in pseudocyst of the pancreas and severe necrotizing pancreatitis (type I, normal duct; type II, duct stricture; type III, duct occlusion or {"}disconnected duct{"}; and type IV, chronic pancreatitis). From 1985 to 2006, a policy was implemented of routine imaging (cross-sectional, endoscopic retrograde cholangiopancreatography, or magnetic resonance cholangiopancreatography). Clinical outcomes were measured. Results: Among 563 patients with pseudocyst, 142 resolved spontaneously (87{\%} of type I, 5{\%} of type II, and no type III, and 3{\%} of type IV). Percutaneous drainage was successful in 83{\%} of type I, 49{\%} of type II, and no type III or type IV. Among 174 patients with severe acute pancreatitis percutaneous drainage was successful in 64{\%} of type I, 38{\%} of type II, and no type III. Operative debridement was required in 39{\%} of type I and 83{\%} and 85{\%} of types II and III, respectively. Persistent fistula after debridement occurred in 27{\%}, 54{\%}, and 85{\%} of types I, II, and III ducts, respectively. Late complications correlated with duct injury. Conclusions: Pancreatic ductal changes predict spontaneous resolution, success of nonoperative measures, and direct therapies in pseudocyst. Ductal changes also predict patients with necrotizing pancreatitis who are most likely to have immediate and delayed complications.",
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