Chronic Pancreatitis

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Permanent pathologic damage to the pancreas results in chronic pancreatitis. In addition to exocrine deficiency (with malabsorption, diabetes, or both), a chronic pain syndrome may evolve and become a management challenge. Many patients suffer from substance abuse and other behavioral problems that require time, patience, compassion, and skill to resolve. Patients who continue to consume alcohol are more likely to have recurrent attacks. Carefully selected patients may benefit from therapeutic ERCP or pancreatic surgery, with some pain relief. Exocrine deficiency may be treated with pancreatic enzyme supplementation with each meal (Apte et al., 1999).

Chronic pancreatitis indicates some degree of progressive and permanent damage to the pancreas, usually visualized as calcifications on radiographs and CT (Figs. 38-18 and 38-19). This damage often leads to diabetes and pancreatic

Figure 38-17 Pancreatitis (CT scan). (Courtesy of Dr. Perry Pernicano.)

Figure 38-18 Chronic pancreatitis with calcifications. (Courtesy Dr. Perry Pernicano.)

Figure 38-19 Pancreatic calcifications. (Courtesy of Dr. Perry Pernicano.)

insufficiency, resulting in malabsorption with chronic diarrhea. Patients with chronic pancreatitis present with repeated attacks of abdominal pain and are often admitted for acute or chronic exacerbations. Potential complications include pseudocyst (Fig. 38-20) and abscess formation, fistula formation between pseudocysts and the gut, persistent pancreatic ascites caused by a disrupted pancreatic duct system, communication with the peritoneal cavity, mes-enteric venous thrombosis, and arterial pseudoaneurysm (Apte et al., 1999).

have not substantially impacted survival. Endoscopic ultrasound and high-resolution CT allow for better preoperative selection for patients likely to benefit from exploration for resection (Fig. 38-21).

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