Objective evaluation of ampullary stenosis with ultrasonography and pancreatic stimulation

Warshaw, Andrew L.; Simeone, Joseph F.; Schapiro, Robert H.; Hedberg, Stephen E.; Mueller, Peter; Ferrucci, Joseph T.

doi:10.1016/s0002-9610(85)80011-8

Cited by 96 publications

(20 citation statements)

References 16 publications

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“…During our endoscopic examination us ing a 0.65-mm needle catheter to cannulate the accessory papilla, it was not possible to measure accurately the orifice size of the PDD. An attempt to objectively demon strate a stenosis of the accessory papilla has been provided recently by Warshaw et al [19] , who observed pancreatic duct dilata tion with ultrasonography after pancreatic stimulation by intravenous secretin injec tion. However, similar studies carried out by Cotton [20] do not find any discriminatory results.…”

Section: Pd: Accessory Papilla Stenosis?mentioning

confidence: 99%

Pancreas divisum: Controversial Clinical Significance

Delhaye

Engelholm²,

Cremer³

1988

Dig Dis

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Section: Pd: Accessory Papilla Stenosis?mentioning

confidence: 99%

Pancreas divisum: Controversial Clinical Significance

Delhaye

Engelholm²,

Cremer³

1988

Dig Dis

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“…Distal ductal dilatation is usually seen in patients with incomplete pancreas divisum with stenosis at the site of ductal fusion, as in one patient in this series. Warshaw et al described the use of ultrasound with secretin stimulation to assess ductal obstruction in adults with pancreatitis 25 and have found a significant correlation between outcome after surgery and ultrasound findings. 14 Other investigators have noted difficulty documenting changes with this study.…”

Section: Discussionmentioning

confidence: 99%

Surgical Management of Recurrent Pancreatitis in Children With Pancreas Divisum

Neblett

O’Neill

2000

Annals of Surgery

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ObjectiveTo analyze an institutional experience with pancreatitis in childhood to clarify the frequency of pancreas divisum in that patient population, the characteristics of pancreatitis in children with pancreas divisum, and the role of surgical management in their treatment. Summary Background DataThe role of pancreas divisum in causing acute and relapsing pancreatitis and chronic, recurring abdominal pain is controversial. Although the anatomical abnormality is present from birth, most investigators have reported cases with onset of symptoms in adulthood. The reported pediatric experience with this disorder is small, and the natural history of pancreatitis in children with pancreas divisum has not been well elucidated. MethodsA retrospective chart review of all children 18 years of age and younger with a discharge diagnosis of pancreatitis identified 135 patients treated in the authors' institution from 1978 to 1998. Ten patients were found to have anatomical variants of pancreas divisum associated with recurrent or chronic pancreatitis. The medical records of these patients were reviewed for data on the presentation, diagnostic findings, imaging studies, treatment, surgical findings, and pathologic findings in these children. Chart review and telephone calls were used to assess the current state of health in nine patients available for follow-up. ResultsPancreas divisum was identified in 7.4% of all children with pancreatitis and 19.2% of children with relapsing or chronic pancreatitis. Patients had early onset of recurrent episodic epigastric pain and vomiting, at a mean age of 6 years. Three patients had a positive family history of pancreatitis and one was proven by DNA analysis to have hereditary pancreatitis. Pancreatitis was documented by elevated amylase or lipase levels, and endoscopic retrograde cholangiopancreatography was the method of diagnosis of pancreas divisum in all patients. Eight patients had complete pancreas divisum and two had incomplete variants. Eight patients underwent surgery to improve ductal drainage. Seven underwent transduodenal sphincteroplasty of the accessory papilla, along with sphincteroplasty of the major papilla in two (plus septoplasty in one). Three patients underwent longitudinal pancreaticojejunostomy, as a primary procedure in one patient with midductal stenosis and in two because of recurring pancreatitis after sphincteroplasty. The surgical findings and histologic examination of five patients undergoing distal pancreatectomy revealed striking changes of advanced chronic pancreatitis. Patients responding to sphincteroplasty alone showed less severe histologic changes. Overall, three of seven patients had excellent results, three were improved, and one had continued disabling attacks of pancreatitis. The mean duration of follow-up was 7.3 years, and there were no deaths. No patients had endocrine or exocrine pancreatic insufficiency, and none required chronic analgesics. ConclusionsPancreas divisum is an important cause of recurrent pancreatitis in childhood and sho...

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“…during pancreatic stimulation) accommodate most of the pancreatic secretions. Arguments in favor of an etiological role for pancreas divisum in acute pancreatitis are: (i) obstructive pancreatitis in pancreas divisum is selectively confined to the dorsal part of the pancreas [13], the ventral part being normal; (ii) after intravenous injection of secretin, the ultrasonographic diameter of the duct of Santorini in pancreas divisum increases further than in normal pancreatic ducts [14]; (iii) in patients with pancreas divisum the dorsal intraductal pressure was significantly higher than in a normally fused pancreas [15]; (iv) papillary stenting, endoscopic [16]or surgical sphincterotomy [7, 17, 18, 19, 20]of the accessory papilla have been proven to prevent recurrence of pancreatic pain as well as acute pancreatitis, and (v) idiopathic pancreatitis is statistically more frequent in pancreas divisum than in a normal pancreas [11]. …”

Section: Discussionmentioning

confidence: 99%

Impacted Papilla Minor Stone in Pancreas divisum Causing Severe Acute Pancreatitis

Renzulli

Müller²,

Uhl³

et al. 1999

Digestion

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This is the first description of severe acute pancreatitis in pancreas divisum caused by a solitary stone impacted in the minor papilla. Recovery was rapid after diagnostic endoscopic retrograde cholangiopancreaticography (ERCP) and endoscopic stone removal. Since other etiological factors accounting for the acute pancreatitis were carefully excluded, it seems that obstruction of the minor papilla by a solitary pancreatic concrement was the most likely cause of acute pancreatitis. This case report demonstrates the diagnostic importance of early ERCP in cases of etiologically unexplained acute pancreatitis.

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Objective evaluation of ampullary stenosis with ultrasonography and pancreatic stimulation

Cited by 96 publications

References 16 publications

Pancreas divisum: Controversial Clinical Significance

Pancreas divisum: Controversial Clinical Significance

Surgical Management of Recurrent Pancreatitis in Children With Pancreas Divisum

Impacted Papilla Minor Stone in Pancreas divisum Causing Severe Acute Pancreatitis

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