AbstractDuring 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.
Vasylyev YuV, Selezneva EYa, Dubtsova EA. Biliary pancreatitis. Eksperimentalnaya i klinicheskaya gastroenterologiya. 2011;7:79-84
Gubergrits NB, Lukashevich GM. Alcohol-related chronic pancreatitis. Moscow. 2010;54.
Dobrov SD, Poliakevich AS, Blagitko E M, Tolstykh GN. Biliary hypertension in patients with chronic pancreatitis. Annaly khirurgicheskoy gepatologii. 2012;35.
Ilchenko AA. Biliary pancreatitis. Eksperimentalnaya i klinicheskaya gastroeneterologiya. 2011;1:3-15.
Kalinina AV. Chronic pancreatitis: diagnostics, treatment, and prevention. Klinicheskiye perspektivy gastroenterologii, gepatologii. 2007;1:3-15.
Kopchak VM, Usenko AYu, Zelinskiy AI. Surgical anatomy of the pancreas. Askaniya. Kyiv. 2011; 141.
Kucheriavyi NV, Tibilova ZF, et al. Mutations in the genes encoding the pancreatic secretory trypsine inhibitor No345 in patients with chronic idiopathic pancreatitis. Eksperimentalnaya i klinicheskaya gastroenterologiya. 2011;7:7-12.
Lazebnik LB, Vinokurova LV, Dubtsova EA, et al. Substantiation of new approaches to comprehensive pathogenetic therapy of patients with chronic pancreatitis. Eksperimentalnaya i klinicheskaya gastroenterologiya. 2011;7:3-6.
Mayev IV, Kucheriavyi YuA. Lithostathines: modern view of biological role and pathogenesis of chronic pancreatitis. Rossiyskiy zhurnal gastroenterologii, gepatologii, koloproktologii. 2006;5:4-10.
Minushkin ON. Chronic pancreatitis: some aspects of pathogenesis, diagnostics, and treatment. CONSILIUM MEDICUM. 2002;4(1).
Korotko GG. Chronic pancreatitis, functional and morphological characteristics (manual for doctors). Korotko GG, editor. Krasnodar. 2002;50.
Yakovenko AV, Grigoryev PYa. Chronic pancreatitis: clinical signs and diagnostics. Eksperimentalnaya i klinicheskaya gastroenterologiya. 2007;6:60-66.
Beger HG, Matsuno S, Cameron JL. Diseases of the Pancreas. Berlin. 2008.
Chen JM, Ferec C. Chronic pancreatitis: genetics and pathogenesis. Ann. Rev. Genomics. Hum. Genet. 2009;10:63-87.
Joergensen M, Brusgaard K, Cruger DG, et al. Incidence, prevalence, etiology, and prognosis of first-time chronic pancreatitis in young patients. Dig. Dis. Sci. 2010;55(10):2988-2998.
Nojgaard C, Becker U, Matzen P, et al. Progression from acute to chronic pancreatitis: prognostic factors, mortality, and natural course. Pancreas. 2011;40(8):1195-1200.
Sebastiano PDi, Mola FFDi. Pathophysiology of Chronic Damage. Acute and Chronic Pancreatitis: New concepts and Evidence-Based Approaches. Turin. 2013:63-69.
Vantini I, Amodio A, Gabbrielli A, Cristofori C, Frulloni L, Benini L. Chronic pancreatitis: clinical course, pancreatic insufficiency and metabolic consequences. Acute and Chronic Pancreatitis: New Concepts and Evidence-Based Approaches. Turin. 2013;71-82.
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