Background
The presence of portal hypertension in chronic pancreatitis imposes great challenges
on the clinician. The objective of this retrospective analysis is to identify the
demographics, presentation, management and outcomes among patients suffering from
chronic pancreatitis with associated portal hypertension.
Patients
The data of fifty-seven patients (36 males, 21 females, age range 23 to 54 years;
median 34.5) with chronic pancreatitis and portal hypertension who were operated either
for intractable pain or complications over a 19-year period were analyzed. The etiology
was alcohol abuse in 28 and idiopathic (tropical) in the remainder. The commonest
presentation was abdominal pain in 52 patients (91%). Only 11 patients presented with
gastrointestinal bleeding (19%), and they were managed by endoscopic therapy (sclerotherapy,
banding, or ethoxysklerol injection). The surgical procedures were: 43 Frey procedures,
11 lateral pancreaticojejunostomies, and 3 Whipple's resections with additional procedures
(cyst/biliary drainage or distal pancreatectomy) when appropriate. Direct operations
for portal hypertension were required in only 19 patients (splenectomy (n = 15) and
gastric devascularization (n = 4)).
Results
Operating times ranged from 210 to 490 minutes (median 320), yet only 11 patients
required blood transfusion. There were 24 complications in 18 patients, and hospital
stay ranged between 11 and 62 days (median 18.5). One patient died of liver failure
on day 17 after operation. Forty-nine out of 53 patients available for follow-up had
excellent or good pain relief.
Conclusion
Surgery provided good relief of pain and complications in patients with chronic pancreatitis
and portal hypertension. Isolated surgery for portal hypertension alone was not required
in any of the patients.
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References
- Extrahepatic portal hypertension caused by chronic pancreatitis.Ann Intern Med. 1971; 75: 903-908
- Recognition and clinical implications of mesenteric and portal vein obstruction in chronic pancreatitis.Arch Surg. 1987; 122: 410-415
- Surgery in tropical pancreatitis: analysis of risk factors.Br J Surg. 1992; 79: 544-549
- Proposal for a new grading system for chronic pancreatitis: the ABC system.J Clin Gastroenterol. 2002; 35: 67-70
- Contribution of splenoportography to the diagnosis of diseases of the pancreas. II. Inflammatory diseases.Acta Med Scand. 1962; 171: 263-272
- The significance of sinistral portal hypertension complicating chronic pancreatitis.Am J Surg. 2000; 179: 129-133
- Splenic and portal venous obstruction in chronic pancreatitis. A prospective longitudinal study of a medical-surgical series of 266 patients.Dig Dis Sci. 1992; 37: 340-346
- Splenoportographic changes in chronic pancreatitis.Surgery. 1968; 63: 571-575
- Splenic vein thrombosis and gastrointestinal bleeding in chronic pancreatitis.World J Surg. 2003; 27: 1271-1274
- Duodenum-preserving head resection in chronic pancreatitis changes the natural course of the disease: a single-center 26-year experience.Ann Surg. 1999; 230: 512-519
- Isolated splenic vein thrombosis.World J Surg. 1985; 9: 384-390
- The natural history of pancreatitis-induced splenic vein thrombosis.Ann Surg. 2004; 239: 876-880
- Splenic and portal venous obstruction in chronic pancreatitis. A prospective longitudinal study of a medical-surgical series of 266 patients.Dig Dis Sci. 1992; 37: 340-346
- Extrahepatic portal hypertension in chronic pancreatitis: an old problem revisited.Ann Surg. 2002; 236: 82-89
- Surgery for nonalcoholic chronic pancreatitis.World J Surg. 1998; 22: 236-239
- Randomized trial of duodenum-preserving pancreatic head resection versus pylorus-preserving Whipple in chronic pancreatitis.Am J Surg. 1995; 169: 65-69
- Prospective randomized study of drainage and resection on non-occlusive segmental portal hypertension in chronic pancreatitis.Br J Surg. 1997; 84: 477-482
- Extrahepatic portal hypertension in chronic pancreatitis: an old problem revisited.Ann Surg. 2002; 236: 82-89
- Ductal drainage with head coring in chronic pancreatitis with small-duct disease.J Hepatobiliary Pancreat Surg. 2003; 10: 366-372
- Association of chronic alcoholic liver and pancreatic disease: a prospective study.Am J Gastroenterol. 1985; 80: 998-1003
- Severe chronic pancreatitis and severe liver cirrhosis have different frequencies and are independent risk factors in male Japanese alcoholics.J Gastroenterol. 2004; 39: 879-887
- A prospective study of pancreatic disease in patients with alcoholic cirrhosis: comparative diagnostic value of ERCP and EUS and long-term significance of isolated parenchymal abnormalities.Gastrointest Endosc. 1999; 49: 705-709
- Concurrent pancreatic ductal changes in alcoholic liver disease.J Gastroenterol Hepatol. 2003; 18: 1067-1070
- The natural history of splenic vein thrombosis due to chronic pancreatitis: indications for surgery.Int J Pancreatol. 1987; 2: 87-92
- Recognition and clinical implications of mesenteric and portal vein obstruction in chronic pancreatitis.Arch Surg. 1987; 122: 410-415
Article info
Publication history
Published online: December 21, 2007
Accepted:
August 25,
2007
Identification
Copyright
© 2008 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
