Twenty-three chronic pancreatitis patients with abnormal liver function or cholangitis were shown at endoscopic retrograde cholangiopancreatography (ERCP) to have common bile duct strictures. Nine were investigated following a single episode of jaundice, 9 after multiple attacks, and 5 presented with an elevated alkaline phosphatase. Jaundice resolved spontaneously in 7 of the 9 patients presenting with a single episode. Fifteen patients required surgery: this was for recurrent or unremitting jaundice in eight, cholangitis in three, unmanageable pain in two, and radiological appearances suspicious of malignancy in two. Five had biliary bypass alone, seven underwent pancreatic resection, one had a pancreatico-jejunostomy, and two, drainage of a pseudocyst. There was one postoperative death following total pancreatectomy. The incidence of continuing pain and insulin-dependent diabetes was similar in the patients treated by biliary bypass or by pancreatic resection; one patient with a bypass had further cholangitis and two with pancreatic resection developed unmanageable steatorrhoea.
展开▼
