Study of Etiological Factors of Chronic Pancreatitis Complicated by Biliary Hypertension

V. I. Pylypchuk, O. L. Dyriv, S. M. Hedzyk

Abstract


During the 2009-2015 time period, 127 patients with complicated forms of chronic pancreatitis (CP) underwent surgical treatment at the Department of General Surgery of the Ivano-Frankivsk Regional Clinical Hospital. CP was accompanied by biliary hypertension (BH) in 39 (30.7%) patients. 14 (11.1%) patients developed BH with concomitant chronic duodenal obstruction (CDO), and in 4 (3.1%) patients a combination of BH+CDO and local venous hypertension (VH) of the vessels in the pancreatobiliary area was found. The analyzed group included 36 (92.3%) men and 3 (7.7%) women at the age of 21 to 60 years. In all 39 patients tubular stenosis of the intrapancreatic part of the choledoch was the morphological substrate of BH due to fibrose-degenerative changes in the pancreatic head; in 9 (23.1%) patients it was combined with cysts of the pancreatic head. In 28 (71.7%) patients, BH had clinical signs (ochrodermia and mucosal icterus, hyperbilirubinemia), and in 11 (28.9%) patients BH was asymptomatic and was diagnosed only by means of ultrasonography (USG) and computed tomography (CT) (tubular stenosis and dilation of the suprapancreatic segment of the common bile duct 0.7 cm to 1.3 – 1.5 cm). In 3 (7.6%) patients, BH was accompanied by the manifestations of cholangitis. All patients with CP complicated by BH underwent surgical treatment. Drainage, resection, and combined surgical interventions were used. In 17 (43.5%) patients CP complicated by BH was the result of acute pancreatitis (1 to 10 years ago), 14 of them underwent surgeries: 2 patients – laparoscopic drainage of the enzymatic peritonitis, 5 patients – laparotomy, drainage of the peritoneal omental sac, abdomen and retroperitoneal space, 5 patients – endoscopic retrograde cholangiopancreatography (ERCP) with drainage of biliary ducts, 2 patients – endoscopic stenting of the pancreatic ducts.  In 4 (10.2%) patients, CP was associated with previous surgeries on the organs of the pancreatobiliary area: 2 patients underwent cholecystectomy due to cholelithiasis, and 2 patients underwent Bilroth II gastrectomy due to duodenal ulcer. In 14 (35.9%) patients their condition was probably caused by cigarette smoking. In 8 (20.5 %) patients, a direct connection between CP and regular alcohol consumption was established. In 7 patients, the causes of CP complicated by BH were not found, and in these cases CP was qualified as idiopathic. Acute destructive pancreatitis is often an etiological factor in the development of CP complicated by BH. BH in case of CP is one of the absolute indications for surgical treatment, and the method of BH correction should be determined individually.


Keywords


chronic pancreatitis; biliary hypertension

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