Skip to main content
NCBI home page
Annals of Surgery logoLink to Annals of Surgery
. 1981 May;193(5):638–648. doi: 10.1097/00000658-198105000-00015

Idiopathic duodenal obstruction: an unappreciated complication of pancreatitis.

E L Bradley 3rd, J L Clements Jr
PMCID: PMC1345138  PMID: 7235767

Abstract

Intestinal obstruction as a complication of pancreatitis is infrequently recognized. Only four cases of idiopathic duodenal obstruction associated with pancreatitis have been previously reported. In a three-year study of 878 patients with pancreatitis, nine cases of idiopathic duodenal obstruction associated with pancreatitis have been found. Each of the nine cases was characterized by frank obstruction in the second or third portions of the duodenum and an intact mucosa in the area of stricture. Four patients gave an abrupt history of moderately severe pancreatitis. Resolution of the duodenal obstruction occurred by three weeks in each of these four cases. Surgical exploration in one of these patients revealed marked duodenal edema with intramural hematoma. The remaining five patients reported a chronic history of obstruction. Inadequate resolution of the obstruction after four weeks of hyperalimentation led to surgical bypass. Duodenal biopsy specimens revealed inflammation, muscle destruction, and extensive fibrosis. Duodenal involvement in the inflammatory process of moderately severe pancreatitis was discovered in 25% of the upper gastrointestinal studies, but was usually self-limiting and of a mild degree. Since contiguous duodenal edema is common and fibrosing pancreatoduodenitis only occurs in an occasional patient, surgical intervention for duodenal obstruction associated with pancreatitis should only be considered after demonstrated failure of conservative management.

Full text

PDF
638

Images in this article

641Fig. 1.
on p.641
641Fig. 2.
on p.641
642Fig. 3.
on p.642
642Fig. 4.
on p.642
643Fig. 5.
on p.643
643Fig. 6.
on p.643
644Fig. 7.
on p.644
645Fig. 8.
on p.645

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Agrawal N. M., Gyr N., McDowell W., Font R. G. Intestinal obstruction due to acute pancreatitis. Case report and review of literature. Am J Dig Dis. 1974 Feb;19(2):179–185. doi: 10.1007/BF01072631. [DOI] [PubMed] [Google Scholar]
  2. Anderson M. C. Pseudocyst of the head of the pancreas: relationship to the duct of Santorini. Ann Surg. 1979 Dec;190(6):719–727. doi: 10.1097/00000658-197912000-00008. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. BRUST R., Jr, CHEN K. C. Acute hemorrhagic pancreatitis complicated by duodenalobstruction. Report of a case. Am J Roentgenol Radium Ther Nucl Med. 1962 Apr;87:732–735. [PubMed] [Google Scholar]
  4. Bradley E. L., Clements J. L., Jr, Gonzalez A. C. The natural history of pancreatic pseudocysts: a unified concept of management. Am J Surg. 1979 Jan;137(1):135–141. doi: 10.1016/0002-9610(79)90024-2. [DOI] [PubMed] [Google Scholar]
  5. Brown R. L., Lang E. K. Chronic pancreatitis causing circumferential narrowing of the duodenum. J La State Med Soc. 1971 May;123(5):177–178. [PubMed] [Google Scholar]
  6. Hunt D. R., Mildenhall P. Etiology of strictures of the colon associated with pancreatitis. Am J Dig Dis. 1975 Oct;20(10):941–946. doi: 10.1007/BF01070880. [DOI] [PubMed] [Google Scholar]
  7. Lindahl F., Vejlsted H., Backer O. G. Lesions of the colon following acute pancreatitis. Scand J Gastroenterol. 1972;7(4):375–378. doi: 10.3109/00365527209180757. [DOI] [PubMed] [Google Scholar]
  8. Lloyd-Jones W., Mountain J. C., Warren K. W. Annular pancreas in the adult. Ann Surg. 1972 Aug;176(2):163–170. doi: 10.1097/00000658-197208000-00008. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Mair W. S., McMahon M. J., Goligher J. C. Stenosis of the colon in acute pancreatitis. Gut. 1976 Sep;17(9):692–695. doi: 10.1136/gut.17.9.692. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Miller T. A., Lindenauer S. M., Frey C. F., Stanley J. C. Proceedings: Pancreatic abscess. Arch Surg. 1974 Apr;108(4):545–551. doi: 10.1001/archsurg.1974.01350280147024. [DOI] [PubMed] [Google Scholar]
  11. Nance F. C., Cocchiara J., Kinder J. L. Acute pancreatitis associated with an intraluminal duodenal diverticulum. Gastroenterology. 1967 Mar;52(3):544–547. [PubMed] [Google Scholar]
  12. Ranson J. H., Lackner H., Berman I. R., Schinella R. The relationship of coagulation factors to clinical complications of acute pancreatitis. Surgery. 1977 May;81(5):502–511. [PubMed] [Google Scholar]
  13. Ranson J. H., Rifkind K. M., Roses D. F., Fink S. D., Eng K., Spencer F. C. Prognostic signs and the role of operative management in acute pancreatitis. Surg Gynecol Obstet. 1974 Jul;139(1):69–81. [PubMed] [Google Scholar]
  14. Reuter S. R., Redman H. C., Joseph R. R. Angiographic findings in pancreatitis. Am J Roentgenol Radium Ther Nucl Med. 1969 Sep;107(1):56–64. doi: 10.2214/ajr.107.1.56. [DOI] [PubMed] [Google Scholar]
  15. SHEIKH H. DUODENAL ISCHAEMIA COMPLICATING ACUTE PANCREATITIS. Br Med J. 1965 Jun 12;1(5449):1539–1540. doi: 10.1136/bmj.1.5449.1539. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Thompson W. M., Kelvin F. M., Rice R. P. Inflammation and necrosis of the transverse colon secondary to pancreatitis. AJR Am J Roentgenol. 1977 Jun;128(6):943–948. doi: 10.2214/ajr.128.6.943. [DOI] [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES