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Prior Acute Pancreatitis Is the Most Common Cause of Obstructive Pancreatitis: A Surgical Series of Distal Pancreatectomy

Objectives The natural history of obstructive pancreatitis is poorly known. We analyzed a consecutive surgical series of distal pancreatectomy to better characterize obstructive pancreatitis. Methods We retrospectively reviewed all patients with obstructive pancreatitis undergoing distal pancreatectomy at our institution from 1990-2005 excluding patients with pancreatic cancer. Obstructive pancreatitis was defined as chronic pancreatitis with: (1) stricture of the main pancreatic duct; (2) normal-appearing pancreas downstream to the stricture, and (3) dilatation of the pancreatic duct upstream to the stricture. Clinical charts were reviewed to determine prior history of acute pancreatitis, and patients were grouped by history of acute pancreatitis. Chi-square, Fisher’s exact, and student’s t-test analysis were used to evaluate differences in demographics and presenting characteristics between groups. Results Forty-eight (5.1%) of 946 patients had obstructive pancreatitis with 39 (81.3%) patients with prior acute pancreatitis and 9 (18.8%) without. Necrotizing pancreatitis was reported in 36% of the patients in the acute pancreatitis group. No necrosis was observed in those individuals without history of acute pancreatitis. Conclusions Prior acute pancreatitis was the most common cause of obstructive pancreatitis; however, nine patients had isolated strictures of the pancreatic duct without prior acute pancreatitis which can be labeled as focal chronic pancreatitis, distinct from other types of chronic pancreatitis both morphologically and etiologically.

Author(s): Daniel K Chan, Michael L Kendrick, Michael B Farnell, Santhi Swaroop Vege

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