Pancreatoduodenectomy for Periampullary Tumors Presenting with Acute Pancreatitis

Abstract

Background. Periampullary tumors (PT) may rarely present as acute pancreatitis (AP) or acute recurrent pancreatitis (ARP). Unlike other cases of AP and ARP, these conditions necessitate pancreaticoduodenectomy (PD), and timely diagnosis is crucial. Materials and Methods. A retrospective review of clinical, radiological, surgical, and pathological data was conducted for patients admitted to the Binzhou Medical University Hospital during the period from January 2010 to December 2017, for AP or ARP caused by PT. All patients included in the study group had undergone PD. The perioperative data for these patients was compared with data for patients with PT but without AP or ARP who underwent PD during the same period (control group). Results. During the study period, 412 patients with AP or ARP were treated; among this group, 15 patients had PT. Compared with controls, patients in the study group were younger in age and had a longer course of disease, more frequent hospitalizations, and more severe derangements in laboratory data (P<0.05). Operative time and intraoperative blood loss were significantly higher in the study group, but the incidence of postoperative outcomes such as pancreatic/biliary fistula, abdominal infection, postoperative hospital stay, and mortality were similar between groups (P>0.05). Conclusions. Neither AP nor ARP has any adverse impact on the outcomes of PD. However, in the treatment of younger patients suffering from AP or ARP, unexplained pancreatic duct dilation and weight loss should raise the suspicion of PT. EUS and EUS-FNA may be helpful in making the diagnosis.

Sex-Related Differences of Acute and Chronic Pancreatitis in Adults

“…Though 85.0% of patients with IPMN were male, rates of secondary AP/RAP were similar among both sexes. In another study investigating patients with AP or RAP secondary to periampullary tumors, two-thirds of the patients were male [ 25 ]. However, the results of the study are limited secondary to small sample size ( n = 15).…”

Complicaciones post-pancreatoduodenectomía de tumores periampulares en una unidad de cirugía hepatopancreatobiliar

“…Los tumores periampulares son un grupo heterogéneo de lesiones originadas alrededor de la ampolla de Vater, cada una con una tasa muy variable de supervivencia a 5 años, al igual que la tasa de complicaciones presentadas 4,9,15 , sin embargo, las manifestaciones clínicas, paraclínicas e imagenológicas tienden a presentar un comportamiento similar. Su presentación clínica es tardía, razón por la cual un bajo porcentaje de los pacientes no son candidatos a manejo quirúrgico.…”

“…El diagnóstico se suele establecer a través de imágenes, como la tomografía computada y/o resonancia magnética, definiéndose además la extensión local o presencia de metástasis, y en sospecha de lesiones que involucren el tracto biliar por colangio-resonancia magnética 2,8 . La manifestación clínica más común es la ictericia, que se presenta en el 80-85% 6,7,9 , además de pérdida de peso, fatiga, dolor abdominal 9 (50%) 7 , pérdida sanguínea gastrointestinal crónica o hemorragias en el transcurso natural de la enfermedad 9 .…”