Inflammation of the pancreas

In acute inflammation of the pancreas, fluid is initially deposited in the cells and swelling (edema) occurs, resulting in cell damage. Since the pancreas is composed esp. of exocrine gland cells, pancreatic enzymes are then released within the pancreatic lodge. This can cause so-called necrotization due to cell death (necrosis) and digestive enzyme properties (approx. 15-20% of cases), which can trigger abscesses (pus accumulation) and excessive circulatory inflammatory reactions. Therefore, acute pancreatitis can be severe and require intensive medical treatment.

A common cause of acute pancreatitis is gallstones that obstruct the common terminal duct. Other causes can be excessive alcohol consumption or certain medications.

Therapy options - surgery advisable?

The therapy can be lengthy. The main focus is on supporting the body with fluids, pain therapy and circulatory stabilization in case of severe inflammatory reactions in an intensive care unit. Antibiotics rarely help.

If pancreatitis does not resolve, drainage (e.g., CT-guided puncture) or surgical removal of affected tissue and irrigation of the abdomen may be indicated in rare cases of necrosis and abscesses. If cell remnants, leaked pancreatic secretions (pancreatic fistula), or a developed abscess form a capsule after pancreatitis has resolved, this is referred to as a pseudocyst. In case of complaints, a discharge into the gastrointestinal tract can be performed in the course of an endoscopy. Only if this is not possible endoscopically, surgery is the means of choice to create a connection between the pseudocyst and the gastrointestinal tract for drainage.

If a gallstone is causative, ERCP (endoscopic retrograde cholangiopancreatography, similar to gastroscopy) can usually be used to remove the stone. After the inflammation has subsided, surgical removal of the gallbladder (often possible by minimally invasive means) should be performed.

(Author: Benedict Kinny-Köster, MD - Surgeon)

In chronic inflammation of the pancreas, there is usually a prolonged irritation that leads to chronic changes in the glandular tissue. The disease progresses in recurrent episodes. The surrounding tissue as well as the pancreas itself fibroses (hardens), and stones may form in the pancreatic duct system or narrowing of the excretory duct (stenosis). As in acute pancreatitis, formation of necrosis, abscesses, and pancreatic fistulas is possible, as well as organization of these areas into pseudocysts over the course of several weeks (about 20% of cases).

Causes are especially chronic alcohol consumption, smoking, certain medications, an autoimmune process or a genetic predisposition. In about 15% of cases, a cause is not clearly identified.

Therapy options - surgery useful?

The decisive factor in treatment is an end to the chronic inflammatory stimulus, e.g. abstinence from alcohol or smoking. In this way, chronic pancreatitis and remodeling processes of the organ can be stopped. However, damage that has already occurred does not regenerate.

Comparable to acute pancreatitis is the need for intensive medical treatment in the case of an excessive immune response affecting the circulatory system. In the case of recurrent episodes and especially in the case of severe pain refractory to therapy, surgical removal of affected tissue is possible. Different techniques are relevant here, depending on the pattern of involvement of the pancreas. In some cases, the duodenum and surrounding structures can be preserved, so that only the pancreatic head or another pancreatic segment is removed or "peeled out" (special surgical procedure that is only possible in chronic pancreatitis).

A study led by researchers at Heidelberg Surgery was able to show that, in addition, a "Whipple operation" (removal of the pancreatic head with the duodenum) with a lower complication rate of a duodenum-preserving operation is a comparably successful surgical technique in terms of long-term therapeutic success.

If the entire organ is affected, complete removal of the pancreas (total pancreatectomy) may be necessary.
If stones in the pancreatic duct or narrowing of the duct are the cause of symptoms, treatment with ERCP and, if necessary, stone removal or stent placement is possible.

(Author: Benedict Kinny-Köster, MD - Surgeon)