J.Jpn. Surg. Soc.. 81(9): 961-965, 1980

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Report on the annual meeting

PATHOLOGICAL FINDINGS AND RESULT OF SURGICAL TREATMENT FOR CHRONIC PANCREATITIS

A pathological study of 104 cases of chronic pancreatitis demonstrated diffuse changes in 61% and localized lesions in 39% of the cases, with pancreatic calcification noted in 64%. The main pancreatic duct was found dilated in 84% with severe ductal dilatation (more than 10 mm in diameter) being observed in 40%. Pancreatic abscess, cyst and carcinoma were present in 2, 27 and 4 cases, respectively, in the series. Histologically, deterioration of pancreatic tissue was more pronounced in alcoholic and idiopathic pancreatitis than in gallstone pancreatitis. Concomitant diabetes mellitus was noted in 35% of cases and 58% gave abnormal glucose tolerance curves on testing with 50 g OGTT. The volume of the islet of Langerhans was reduced to 1/2 of that of controls, however, there was no distinct parallelism between the degree of glucose intolerance and volume reduction of the islet of Langerhans.
Chronic pancreatitis was complicated by peptic ulcer in 16.5% of cases studied and its concurrence rate was as high as 28.6% in cases of alcholic pancreatitis. Since, however, serum gastrin levels and gastric acid secretion were not necessarily elevated, some other factors seem to be involved in the pathogenetic mechanism of these ulcers.
The immediate operative mortality in this series was 6.7%. The long-term result of surgical treatment was rated as good in 56%, as fair in 20% and as unchanged in 9%, with 16% of cases having a fatal outcome. The cause of death was intercurrent diabetes mellitus in most instances. Cases of localized pancreatitis undergoing pancreatectomy as well as those of gallstone pancreatitis tended to have a favorable long-term result, while 51% of cases of diffuse pancreatitis treated by pancreaticojejunostomy also had a good long-term result.

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