Surgical approaches to chronic pancreatitis

indications and imaging findings

Nima Hafezi-Nejad, Vikesh Singh, Stephen I. Johnson, Martin A Makary, Kenzo Hirose, Elliot K Fishman, Atif Zaheer

Research output: Contribution to journalArticle

Abstract

Chronic pancreatitis (CP) is an irreversible, inflammatory process characterized by progressive fibrosis of the pancreas that can result in abdominal pain, exocrine insufficiency, and diabetes. Inadequate pain relief using medical and/or endoscopic therapies is an indication for surgery. The surgical management of CP is centered around three main operations including pancreaticoduodenectomy (PD), duodenum-preserving pancreatic head resection (DPPHR) and drainage procedures, and total pancreatectomy with islet autotransplantation (TPIAT). PD is the method of choice when there is a high suspicion for malignancy. Combined drainage and resection procedures are associated with pain relief, higher quality of life, and superior short-term and long-term survival in comparison with the PD. TPIAT is a reemerging treatment that may be promising in subjects with intractable pain and impaired quality of life. Imaging examinations have an extensive role in pre-operative and post-operative evaluation of CP patients. Pre-operative advanced imaging examinations including CT and MRI can detect hallmarks of CP such as calcifications, pancreatic duct dilatation, chronic pseudocysts, focal pancreatic enlargement, and biliary ductal dilatation. Post-operative findings may include periportal hepatic edema, pneumobilia, perivascular cuffing and mild pancreatic duct dilation. Imaging can also be useful in the detection of post-operative complications including obstructions, anastomotic leaks, and vascular lesions. Imaging helps identify unique post-operative findings associated with TPIAT and may aid in predicting viability and function of the transplanted islet cells. In this review, we explore surgical indications as well as pre-operative and post-operative imaging findings associated with surgical options that are typically performed for CP patients.

Original languageEnglish (US)
Pages (from-to)1-17
Number of pages17
JournalAbdominal Radiology
DOIs
StateAccepted/In press - May 20 2016

Fingerprint

Chronic Pancreatitis
Pancreatectomy
Pancreaticoduodenectomy
Autologous Transplantation
Dilatation
Pancreatic Ducts
Drainage
Quality of Life
Pancreatic Pseudocyst
Pain
Intractable Pain
Anastomotic Leak
Islets of Langerhans
Duodenum
Abdominal Pain
Blood Vessels
Pancreas
Edema
Fibrosis
Survival

Keywords

  • Chronic pancreatitis
  • Duodenum-preserving pancreatic head resection
  • Imaging
  • Islet autotransplantation
  • Pancreaticoduodenectomy
  • Total pancreatectomy

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology
  • Urology
  • Radiological and Ultrasound Technology

Cite this

Surgical approaches to chronic pancreatitis : indications and imaging findings. / Hafezi-Nejad, Nima; Singh, Vikesh; Johnson, Stephen I.; Makary, Martin A; Hirose, Kenzo; Fishman, Elliot K; Zaheer, Atif.

In: Abdominal Radiology, 20.05.2016, p. 1-17.

Research output: Contribution to journalArticle

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