CHRONIC-PANCREATITIS - CAUSE OF BILIARY STRICTURE

Abstract

Patients (13) who had a distal common duct stricture associated with chronic relapsing pancreatitis were reported. All patients, when first seen, had an elevated alkaline phosphatase level; 8 of 13 patients had an elevated serum bilirubin level. Of the jaundiced patients, 5 had a febrile course; a preoperative diagnosis of acute cholangitis was made in 4 of these. Of the 13 patients, 8 had a choledochoduodenostomy for relief of biliary obstruction; 7 of these patients are living and well, 1 died of continued alcoholism and pancreatitis. One patient had a loop cholecystojejunostomy; decompression was inadequate and death due to septicemia secondary to ascending cholangitis ensued. Patients (4) have not yet had an operation. Two are symptomatic, but elective operation was refused. Two have been lost to follow-up. Investigation of the biliary tract is recommended in patients known to have chronic relapsing pancreatitis who have persisting abdominal symptoms and an elevated alkaline phosphatase. If a stricture of the distal common bile duct is identified in the absence of acute pancreatitis, choledochoduodenostomy should be performed.