Postoperative pancreatitis: A study of seventy cases*****

TLDR: It is not difficult to appreciate that trauma to the pancreatic tissue and ducts or to the surrounding structures could cause edema, obstruction of the ducts, impairment of the blood supply, and subsequent autodigestion.

Abstract: Summary It is not difficult to appreciate that trauma to the pancreatic tissue and ducts or to the surrounding structures could cause edema, obstruction of the ducts, impairment of the blood supply, and subsequent autodigestion. Secondly, there is some evidence that hypovolemic shock may precipitate pancreatitis. The formation of microthrombi is possibly a common factor in instances in which local trauma is absent. Thirdly, depressed trypsin inhibitor activity after operations reduces tissue immunity to autodigestion. The following factors are important in the prevention and treatment of postoperative pancreatitis: o 1. Meticulous attention to general operative technics is a self-evident requirement in gastric and biliary surgery. 2. Bakes' dilators greater than 3 mm should not be used. If stenosis of the ampulla of Vater is suspected, transduodenal sphincterotomy should be carried out. One should avoid high pressure injections when doing syringe cholangiograms. 3. In cases in which there is a question of possible obstruction to the pancreatic duct, external drainage by cannulating the duct will provide free passage of pancreatic secretions to the outside until local edema has disappeared. 4. Long-arm T tubes should not be used; if found to be the basis of an attack of acute pancreatitis, they should be removed and replaced with a short-arm tube.