eMedicine Specialties > Radiology > Gastrointestinal

Pancreatitis, Chronic: Follow-up

Author: Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR, LRCP, Chairman of Medical Imaging, Professor of Radiology, NGHA, King Fahad National Guard Hospital, King Abdulaziz Medical City, Riyadh, Saudi Arabia
Coauthor(s): Sumaira MacDonald, MBChB, PhD, MRCP, FRCR, Lecturer, Sheffield University Medical School; Endovascular Fellow, Sheffield Vascular Institute; Aali J Sheen, MD, MBChB, FRCS, Consulting Hepatobiliary Surgeon, HepatoBiliary Unit, Manchester Royal Infirmary
Contributor Information and Disclosures

Updated: Mar 12, 2009

Intervention

Image-guided pancreatic biopsy may be performed. Usually, a cytologist is present at the biopsy, because immediate tissue analysis reduces the need for multiple biopsies. Fine-needle biopsy is usually performed because of the risk of acute pancreatitis with the use of larger needles.

Patients with acute biliary obstruction in the context of active pancreatitis, with or without pseudocyst in the head of the pancreas, can be treated by using temporary biliary stents. The value of dilatation and stent placement in the pancreatic duct has not yet been established. Currently, patients with recurrent acute episodes of pancreatitis may be treated with dilation of pancreatic duct strictures or the placement of temporary pancreatic duct stents. Further studies are necessary to establish the long-term benefits.

Surgical approaches are occasionally attempted to control intractable pain. These procedures include celiac ganglionectomies, splanchnicectomies, and various resections of the pancreas. Surgical series report a 70-90% success rate in alleviating pain. The surgical repair of leaks demonstrated on ERCP may be required.

Medical treatment consists of large-volume paracentesis and total parenteral nutrition. The treatment of pancreatic ascites may be difficult.

Medicolegal Pitfalls

  • The use of large biopsy needles should be avoided because of the risk of acute pancreatitis.
  • The close relationship of the aorta, inferior vena cava, and mesenteric vessels to the pancreas makes the risk of hemorrhage from a pancreatic biopsy significant.
  • Established biliary strictures in end-stage chronic calcific pancreatitis usually do not respond to endoscopically placed stents. In such cases, surgery should be performed whenever possible.
  • Chronic pancreatitis should be considered in the differential diagnosis of focal pancreatic masses, even in the absence of supporting clinical evidence.18
 


More on Pancreatitis, Chronic

Overview: Pancreatitis, Chronic
Imaging: Pancreatitis, Chronic
Follow-up: Pancreatitis, Chronic
Multimedia: Pancreatitis, Chronic
References
Further Reading
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References

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Keywords

chronic pancreatitis, pancreatitis, pancreas, chronic calcifying pancreatitis, chronic obstructive pancreatitis, chronic inflammatory pancreatitis, pancreatic dysfunction, alcoholic pancreatitis, calcific pancreatitis, obstructive pancreatitis, inflammatory pancreatitis, pancreatic pseudotumor, autoimmune pancreatitis.

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Contributor Information and Disclosures

Author

Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR, LRCP, Chairman of Medical Imaging, Professor of Radiology, NGHA, King Fahad National Guard Hospital, King Abdulaziz Medical City, Riyadh, Saudi Arabia
Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR, LRCP is a member of the following medical societies: American Institute of Ultrasound in Medicine, Royal College of Physicians, Royal College of Physicians and Surgeons of the United States, Royal College of Radiologists, and Royal College of Surgeons of England
Disclosure: Nothing to disclose.

Coauthor(s)

Sumaira MacDonald, MBChB, PhD, MRCP, FRCR, Lecturer, Sheffield University Medical School; Endovascular Fellow, Sheffield Vascular Institute
Sumaira MacDonald, MBChB, PhD, MRCP, FRCR is a member of the following medical societies: British Medical Association, Royal College of Physicians, and Royal College of Radiologists
Disclosure: Nothing to disclose.

Aali J Sheen, MD, MBChB, FRCS, Consulting Hepatobiliary Surgeon, HepatoBiliary Unit, Manchester Royal Infirmary
Aali J Sheen, MD, MBChB, FRCS is a member of the following medical societies: British Medical Association, International Hepato-Pancreato-Biliary Association, and Royal College of Surgeons of England
Disclosure: Nothing to disclose.

Medical Editor

Glenn Krinsky, MD, Chief of Abdominal Imaging Section, Associate Professor, Department of Radiology, New York University School of Medicine
Glenn Krinsky, MD is a member of the following medical societies: Alpha Omega Alpha and Radiological Society of North America
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

Managing Editor

Udo P Schmiedl, MD, PhD, Clinical Professor, Department of Radiology, University of Washington; Consulting Staff, Swedish Medical Center, University of Washington Medical Center, Seattle Radiologists
Udo P Schmiedl, MD, PhD is a member of the following medical societies: American College of Radiology and Radiological Society of North America
Disclosure: Nothing to disclose.

CME Editor

Robert M Krasny, MD, Consulting Staff, Department of Radiology, The Angeles Clinic and Research Institute
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

John Karani, MBBS, FRCR, Consulting Staff, Department of Radiology, King's College Hospital, London
Disclosure: Nothing to disclose.

 
 
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