[Acute pancreatitis after resection of stomach for low duodenal ulcer]

Abstract

Results of the treatment of 71 patients with postbulbar ulcer of the duodenum are presented. Stomach resection by Bilrot-II was performed in 22 (30.9%) patients, by Bilrot-I--in 2 (2.8%), by Roux with plastic reconstruction of duodenal stump with intestinal tube--in 16 (22.5%) patients. Precardial proximal vagotomy with drainage operation was performed in 31 (43.6%) patients with massive periulcerous infiltration. Acute postoperative pancreatitis (APP) was seen in 29 (40.8%) patients chiefly after resection of stomach, 6 (8.4%) of them had pancreonecrosis. Postoperative lethality in the group of patients with APP was 12.6%. Ultrasonic examination of the pancreas and its vascular structures is the main method for diagnosis of postoperative pancreatitis. The cause of APP is the mechanic deformation and spasm of major duodenal papilla (MDP) that may be associated with cholinergic denervation and edema of MDP after resection and trauma of tissues. The removal of MDP spasm is an effective prophylactic measure for elimination of pancreatic hypertension. One of the methods of removal of MDP spasm is periarterial sympathectomy of gastroduodenal artery and prolonged drug blockade of celiac plexus in addition to stomach resection.