Skip to main content
PMC home page
Gut logoLink to Gut
. 1992 Nov;33(11):1566–1571. doi: 10.1136/gut.33.11.1566

Minimal change chronic pancreatitis.

T N Walsh 1, J Rode 1, B A Theis 1, R C Russell 1
PMCID: PMC1379548  PMID: 1452086

Abstract

In patients with severe abdominal pain, of pancreatic origin, there are a few with minimal or equivocal findings on pancreatic investigation and in whom the aetiology of their pancreatic disease is elusive. The findings and outcome in 16 of these patients (four men and 12 women) who underwent resection are reported. Pancreatic imaging showed minimal or equivocal findings in all 16; pancreas divisum was present in five. All were managed conservatively at first but resection was required for progression of symptoms. A drainage procedure was performed initially in five patients but relief of pain was at best transitory before further surgery was required. Partial resection was needed in 12, of whom eight required subsequent completion pancreatectomy and four had a one stage total resection. Nine patients are currently pain free after resection or are very much improved, while six are no better and one patient has died from an unrelated cause. Histology of resected specimens showed chronic inflammatory changes accompanied by subtle non-inflammatory changes in all but one. These changes include duct proliferation, duct complex formation, adenomatous nodules, and acinar cell atrophy, the significance of which is unclear. These findings suggest a syndrome of minimal macroscopic and radiological change chronic pancreatitis with pain as its chief clinical feature and a distinct histology, the aetiology of which is unclear. It seems that there is a distinct syndrome of minimal change pancreatitis, among the group of patients which presents with the clinical features of chronic pancreatitis.

Full text

PDF
1566

Images in this article

1569Figure 1
on p.1569
1569Figure 2
on p.1569
1569Figure 3
on p.1569
1570Figure 4
on p.1570
1570Figure 5
on p.1570
1570Figure 6
on p.1570

Selected References

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

  1. Axon A. T. Endoscopic retrograde cholangiopancreatography in chronic pancreatitis. Cambridge classification. Radiol Clin North Am. 1989 Jan;27(1):39–50. [PubMed] [Google Scholar]
  2. Beger H. G., Büchler M., Bittner R. The duodenum preserving resection of the head of the pancreas (DPRHP) in patients with chronic pancreatitis and an inflammatory mass in the head. An alternative surgical technique to the Whipple operation. Acta Chir Scand. 1990 Apr;156(4):309–315. [PubMed] [Google Scholar]
  3. Bockman D. E., Boydston W. R., Parsa I. Architecture of human pancreas: implications for early changes in pancreatic disease. Gastroenterology. 1983 Jul;85(1):55–61. [PubMed] [Google Scholar]
  4. Bradley E. L., 3rd Pancreatic duct pressure in chronic pancreatitis. Am J Surg. 1982 Sep;144(3):313–316. doi: 10.1016/0002-9610(82)90008-3. [DOI] [PubMed] [Google Scholar]
  5. Büchler M., Weihe E., Friess H., Malfertheiner P., Bockman E., Müller S., Nohr D., Beger H. G. Changes in peptidergic innervation in chronic pancreatitis. Pancreas. 1992;7(2):183–192. doi: 10.1097/00006676-199203000-00009. [DOI] [PubMed] [Google Scholar]
  6. Ebbehøj N., Borly L., Bülow J., Rasmussen S. G., Madsen P. Evaluation of pancreatic tissue fluid pressure and pain in chronic pancreatitis. A longitudinal study. Scand J Gastroenterol. 1990 May;25(5):462–466. doi: 10.3109/00365529009095516. [DOI] [PubMed] [Google Scholar]
  7. Ihse I. Pancreatic pain. Br J Surg. 1990 Feb;77(2):121–122. doi: 10.1002/bjs.1800770202. [DOI] [PubMed] [Google Scholar]
  8. Longnecker D. S., Curphey T. J. Adenocarcinoma of the pancreas in azaserine-treated rats. Cancer Res. 1975 Aug;35(8):2249–2258. [PubMed] [Google Scholar]
  9. Lotz M., Vaughan J. H., Carson D. A. Effect of neuropeptides on production of inflammatory cytokines by human monocytes. Science. 1988 Sep 2;241(4870):1218–1221. doi: 10.1126/science.2457950. [DOI] [PubMed] [Google Scholar]
  10. Noronha M., Bordalo O., Dreiling D. A. Alcohol and the pancreas. II. Pancreatic morphology of advanced alcoholic pancreatitis. Am J Gastroenterol. 1981 Aug;76(2):120–124. [PubMed] [Google Scholar]
  11. Noronha M., Dreiling D. A., Bordalo O. Sequential changes from minimal pancreatic inflammation to advanced alcoholic pancreatitis. Z Gastroenterol. 1983 Nov;21(11):666–673. [PubMed] [Google Scholar]
  12. Nyberg F., Le Grevés P., Terenius L. Modulation of endopeptidase activity by calcitonin gene related peptide: a mechanism affecting substance P action? Biochimie. 1988 Jan;70(1):65–68. doi: 10.1016/0300-9084(88)90159-9. [DOI] [PubMed] [Google Scholar]
  13. Oertel J. E. The pancreas. Nonneoplastic alterations. Am J Surg Pathol. 1989;13 (Suppl 1):50–65. [PubMed] [Google Scholar]
  14. Okazaki K., Yamamoto Y., Kagiyama S., Tamura S., Sakamoto Y., Nakazawa Y., Morita M., Yamamoto Y. Pressure of papillary sphincter zone and pancreatic main duct in patients with chronic pancreatitis in the early stage. Scand J Gastroenterol. 1988 May;23(4):501–507. doi: 10.3109/00365528809093901. [DOI] [PubMed] [Google Scholar]
  15. PORTA E. A., STEIN A. A., PATTERSON P. ULTRASTRUCTURAL CHANGES OF THE PANCREAS AND LIVER IN CYSTIC FIBROSIS. Am J Clin Pathol. 1964 Nov;42:451–465. doi: 10.1093/ajcp/42.5.451. [DOI] [PubMed] [Google Scholar]
  16. Sarner M., Cotton P. B. Classification of pancreatitis. Gut. 1984 Jul;25(7):756–759. doi: 10.1136/gut.25.7.756. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Sato T., Miyashita E., Yamauchi H., Matsuno S. The role of surgical treatment for chronic pancreatitis. Ann Surg. 1986 Mar;203(3):266–271. doi: 10.1097/00000658-198603000-00008. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Takahashi M., Arai H., Kokubo T., Furukawa F., Kurata Y., Ito N. An ultrastructural study of precancerous and cancerous lesions of the pancreas in Syrian golden hamsters induced by N-nitrosobis(2-oxopropyl)amine. Gan. 1980 Dec;71(6):825–831. [PubMed] [Google Scholar]
  19. Tasso F., Stemmelin N., Sarles H., Clop J. Comparative morphometric study of the human pancreas in its normal state and in primary chronic calcifying pancreatitis. Biomedicine. 1973 Mar;18(2):134–144. [PubMed] [Google Scholar]
  20. Way L. W., Gadacz T., Goldman L. Surgical treatment of chronic pancreatitis. Am J Surg. 1974 Feb;127(2):202–209. doi: 10.1016/0002-9610(74)90158-5. [DOI] [PubMed] [Google Scholar]
  21. White T. T., Slavotinek A. H. Results of surgical treatment of chronic pancreatitis. Report of 142 cases. Ann Surg. 1979 Feb;189(2):217–224. doi: 10.1097/00000658-197902000-00014. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Gut are provided here courtesy of BMJ Publishing Group

RESOURCES