Skip to main content
PMC home page
Annals of The Royal College of Surgeons of England logoLink to Annals of The Royal College of Surgeons of England
. 1992 Mar;74(2):119–125.

Chronic pancreatitis with biliary obstruction.

W K Huizinga 1, S R Thomson 1, J M Spitaels 1, A E Simjee 1
PMCID: PMC2497519  PMID: 1567130

Abstract

In a 4-year review of 509 patients with chronic pancreatitis, the incidence of clinically manifest fixed common bile duct (CBD) stenosis was 9% (45 patients). In 76% this was alcohol related, and pancreatic calcification was present in 51%. All patients presented with unrelenting jaundice and five (11%) had cholangitis. The mean serum bilirubin (165 +/- 108, normal 0-17 mumol/l), alkaline phosphatase (1790 +/- 1143, normal 73-207 U/l) and gamma glutamyl transferase (798 +/- 660, normal 7-64 U/l) were markedly raised. Diabetes occurred in 8 (18%). A biliary drainage operation was performed in 43 patients and 11 had concomitant pancreaticojejunostomy. Endoscopic retrograde cholangiopancreatography (ECRP) provided valuable information preoperatively in outlining both biliary and pancreatic disease in selecting patients for dual ductal drainage. Minor complications not related to biliary anastomosis occurred in 14%. Four patients died (9%), two from pseudocyst-related haemorrhage. Jaundice was successfully relieved in all and did not recur during follow-up. No secondary biliary cirrhosis was encountered, but varying degrees of portal fibrosis were present in 75% of liver biopsies. The commonest biliary pathogen was E. coli. It is recommended that a biliary bypass operation be performed when the diagnosis is radiologically confirmed and no improvement occurs within 1 month.

Full text

PDF
119

Images in this article

120Figure
on p.120
120Figure
on p.120

Selected References

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

  1. Afroudakis A., Kaplowitz N. Liver histopathology in chronic common bile duct stenosis due to chronic alcoholic pancreatitis. Hepatology. 1981 Jan-Feb;1(1):65–72. doi: 10.1002/hep.1840010111. [DOI] [PubMed] [Google Scholar]
  2. Angelini G., Merigo F., Degani G., Camplani N., Bovo P., Fratta Pasini A., Cavallini G., Brocco G., Scuro L. A. Association of chronic alcoholic liver and pancreatic disease: a prospective study. Am J Gastroenterol. 1985 Dec;80(12):998–1003. [PubMed] [Google Scholar]
  3. Aranha G. V., Prinz R. A., Freeark R. J., Greenlee H. B. The spectrum of biliary tract obstruction from chronic pancreatitis. Arch Surg. 1984 May;119(5):595–600. doi: 10.1001/archsurg.1984.01390170091018. [DOI] [PubMed] [Google Scholar]
  4. Brinton M. H., Pellegrini C. A., Stein S. F., Way L. W. Surgical treatment of chronic pancreatitis. Am J Surg. 1984 Dec;148(6):754–759. doi: 10.1016/0002-9610(84)90431-8. [DOI] [PubMed] [Google Scholar]
  5. Cainzos M., Potel J., Puente J. L. Anergy in jaundiced patients. Br J Surg. 1988 Feb;75(2):147–149. doi: 10.1002/bjs.1800750219. [DOI] [PubMed] [Google Scholar]
  6. Dutta S. K., Mobrahan S., Iber F. L. Associated liver disease in alcoholic pancreatitis. Am J Dig Dis. 1978 Jul;23(7):618–622. doi: 10.1007/BF01072596. [DOI] [PubMed] [Google Scholar]
  7. Huizinga W. K., Kalideen J. M., Bryer J. V., Bell P. S., Baker L. W. Control of major haemorrhage associated with pancreatic pseudocysts by transcatheter arterial embolization. Br J Surg. 1984 Feb;71(2):133–136. doi: 10.1002/bjs.1800710219. [DOI] [PubMed] [Google Scholar]
  8. Kalvaria I., Bornman P. C., Marks I. N., Girdwood A. H., Bank L., Kottler R. E. The spectrum and natural history of common bile duct stenosis in chronic alcohol-induced pancreatitis. Ann Surg. 1989 Nov;210(5):608–613. doi: 10.1097/00000658-198911000-00007. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Nealon W. H., Townsend C. M., Jr, Thompson J. C. Preoperative endoscopic retrograde cholangiopancreatography (ERCP) in patients with pancreatic pseudocyst associated with resolving acute and chronic pancreatitis. Ann Surg. 1989 May;209(5):532–540. doi: 10.1097/00000658-198905000-00004. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Pereira-Lima L., Kalil A. N., Wilson T. J. Surgical treatment of chronic pancreatic cholangiopathy. Br J Surg. 1989 Nov;76(11):1129–1131. doi: 10.1002/bjs.1800761107. [DOI] [PubMed] [Google Scholar]
  11. Sarles H., Sahel J. Cholestasis and lesions of the biliary tract in chronic pancreatitis. Gut. 1978 Sep;19(9):851–857. doi: 10.1136/gut.19.9.851. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Scott J., Summerfield J. A., Elias E., Dick R., Sherlock S. Chronic pancreatitis: a cause of cholestasis. Gut. 1977 Mar;18(3):196–201. doi: 10.1136/gut.18.3.196. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Stahl T. J., Allen M. O., Ansel H. J., Vennes J. A. Partial biliary obstruction caused by chronic pancreatitis. An appraisal of indications for surgical biliary drainage. Ann Surg. 1988 Jan;207(1):26–32. doi: 10.1097/00000658-198801000-00007. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Warshaw A. L., Rattner D. W. Facts and fallacies of common bile duct obstruction by pancreatic pseudocysts. Ann Surg. 1980 Jul;192(1):33–37. doi: 10.1097/00000658-198007000-00006. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Wilson C., Auld C. D., Schlinkert R., Hasan A. H., Imrie C. W., MacSween R. N., Carter D. C. Hepatobiliary complications in chronic pancreatitis. Gut. 1989 Apr;30(4):520–527. doi: 10.1136/gut.30.4.520. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Yadegar J., Williams R. A., Passaro E., Jr, Wilson S. E. Common duct stricture from chronic pancreatitis. Arch Surg. 1980 May;115(5):582–586. doi: 10.1001/archsurg.1980.01380050012004. [DOI] [PubMed] [Google Scholar]

Articles from Annals of The Royal College of Surgeons of England are provided here courtesy of The Royal College of Surgeons of England

RESOURCES