Surgical Treatment and Morphological Aspects of Duodenal Dystrophy
https://doi.org/10.16931/1995-5464.2016383-91
Abstract
Aim. To investigate the pathogenesis of cystic inflammatory transformation of duodenal wall in patients with chronic
pancreatitis (CP), described as a “duodenal dystrophy” (DD), and to improve clinical efficiency of surgical treatment.
Material and Methods. 532 patients with CP were examined for the period 2004–2016. Eighty two (15.4%) patients with DD were retrospectively included over 12 years. The diagnosis of DD was established by transabdominal ultrasound, CT, MRI and endosonography. Initially, all patients were treated conservatively. 74 patients required surgical treatment subsequently after conservative treatment with a median duration of 2 years. 34 patients underwent pancreaticoduodenectomy (PD), 21 patients underwent duodenal resection, 15 – duodenum-preserving pancreatic head resection of (DPPHR). 4 patients underwent palliative operations. CP and DD were verified by histological study of surgical specimens. Not operated patients (8) are under observation. Long-term results of surgical treatment were evaluated in 47 patients with a median follow-up 49.9 months.
Results. Histological examination resulted that in 69.9% DD was related with groove pancreatitis, with ectopic pancreatic tissue – in 30.1%. DD was associated with CP in 92.6% of cases. Clinical presentation of DD was not related with etiology and showed typical symptoms of CP: abdominal pain occurred in 98.8% of patients, body weight loss – 61.7%, duodenal obstruction – 35.8%, biliary hypertension – 34.6%. The overall morbidity was 35.6%. Overall
postoperative mortality was 1.37% (1 patient). 66% of patients had no clinical symptoms postoperatively, a significant improvement – 32%, no effect – 2%.
Conclusion. The most cases DD is related with groove pancreatitis, less frequently – with ectopic pancreatic tissue in the duodenal wall. Typically DD occurs in patients with CP. Treatment of patients with CP and DD should be started with conservative therapy. Surgery is indicated for persistent abdominal pain and presence of CP complications. Procedures of choice are PD and DPPHR.
About the Authors
A. G. Kriger
A.V. Vishnevsky Institute of Surgery
Russian Federation
Doct. of Med. Sci., Professor, Head of the Abdominal Surgery Department
Russian Federation
Doct. of Med. Sci., Professor, Head of the Abdominal Surgery Department
O. V. Paklina
A.V. Vishnevsky Institute of Surgery
Russian Federation
Russian Federation
Doct. of Med. Sci., Professor, Principal Research Scientist
of the Pathology Department; Head of the Pathology Department of S.P. Botkin City Clinical Hospital
A. V. Smirnov
A.V. Vishnevsky Institute of Surgery
Russian Federation
Postgraduate Student
Russian Federation
Postgraduate Student
S. V. Berelavichus
A.V. Vishnevsky Institute of Surgery
Russian Federation
Russian Federation
Cand. of Med. Sci., Senior Researcher at the Abdominal Surgery Department
D. S. Gorin
A.V. Vishnevsky Institute of Surgery
Russian Federation
Russian Federation
Cand. of Med. Sci., Researcher at the Abdominal Surgery Department
G. G. Karmazanovsky
A.V. Vishnevsky Institute of Surgery
Russian Federation
Doct. of Med. Sci., Professor, Head of Radiology Department
Russian Federation
Doct. of Med. Sci., Professor, Head of Radiology Department
D. V. Kalinin
A.V. Vishnevsky Institute of Surgery
Russian Federation
Cand. of Med. Sci., Head of the Pathology Department
Russian Federation
Cand. of Med. Sci., Head of the Pathology Department
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Review
For citations:
Kriger A.G., Paklina O.V., Smirnov A.V., Berelavichus S.V., Gorin D.S., Karmazanovsky G.G., Kalinin D.V. Surgical Treatment and Morphological Aspects of Duodenal Dystrophy. Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery. 2016;21(3):83-91. (In Russ.) https://doi.org/10.16931/1995-5464.2016383-91
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