The Physiological Basis for the Surgical Management of Acute and Chronic Pancreatitis

Doubilet, Henry

doi:10.1016/s0039-6109(16)35441-x

Cited by 18 publications

(9 citation statements)

References 8 publications

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“…The free peritoneal fluid frequently contains bile, and Sinclair (1959) states that at autopsy the bile staining of the pancreas and retroperitoneal tissues is a common finding. Doubilet (1958) states that under maximal stimulation the pressure on the biliary tree and in the pancreas rises to 300-400 mm. of water, but under normal conditions is usually around 150 mm.…”

Section: Indications For Surgerymentioning

confidence: 99%

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External choledochoduodenostomy. An evaluation of 125 cases

Wm¹

1961

Journal of British Surgery

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EXTERNAL choledochoduodenostomy is an operation which, although it has been practised for well over 70 years, has had varying degrees of popularity, and has never been widely accepted. The uncertainty has probably arisen from the fact that, although small groups of cases have been spasmodically reported from various centres, no large group has been analysed to determine the long-term effects, both on the common duct itself, and secondarily on the liver. Moreover, certain cases have been quoted from time to time where the common bile-duct after choledochoduodenostomy has become occluded by food debris such as tomato skin, leading to intermittent jaundice and fever. Most surgeons have therefore been very cautious about the operation. Obviously a follow-up on this operation must first of all determine whether the stoma remains patent; previous reports seem to have neglected this aspect. The following survey of 125 cases, operated on between 1947 and 1960, has been carried out over the last 3 years in order to determine the above and other factors, and generally to evaluate the operation. The average interval between operation and review was 5 years 3 months, the longest 10 years and 3 months, and the shortest 12 months. HISTORYRiedel was the first to report the operation in a brief paper produced in July, 1888 (I888a, b). Plenk (Plenk and Hartl, 1949; Hartl and Raindl, 1951) of Lenz, in 1949, reported on 95 cases he had treated privately, with I post-operative death. Seventy-one of these cases had a frankly purulent cholangitis secondary to stones. H e also described 293 hospital cases and states that no case of post-operative ascending cholangitis had been encountered in any of these. He emphasized that purulent cholangitis would be cured if the stoma was large enough, as the most important thing was drainage. Becker Bernhard (1950) insisted that purulent cholangitis was not an ascending infection from the duodenum but a descending, and that all cholangitis is rapidly cured when the bile can escape freely. He regarded the operation simply as the right way of draining an abscess.Finsterer wrote several papers on the subject from 1932 onwards (1932, 1942a, b, 1952), and in 1952 reported enthusiastically on 233 cases where the operation was carried out largely for suppurative cholangitis, or when white bile was present. Many of these cases were done at the time of famine edema, and yet his mortality was 12 per cent. This was less than his mortality for drainage of the common duct, which was 21 per cent, and for transduodenal choledochotomy, which was 27 per cent. He noted that, with a follow-up of from 3 to 25 years, the late results were good and no ascending infection was observed. Three were reported not cured and in 2 cases the stoma had closed. He found that the late results were better than after biliary drainage or transduodenal exploration of the ampulla. He emphasized that the operation gave a lower mortality and better longterm results, and that it was essential for the stoma to be 2-3 cm. in length.Sanders...

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Section: Indications For Surgerymentioning

confidence: 99%

“…When the sphincter is sectioned, the residual resistance to flow is about IOO mm. water (Doubilet, 1958). Newman and Northup (1957) state that in order for a sphincterotomy to be complete, not only the fibres of the papilla should be divided, but also the more powerful choledochal muscle.…”

Section: Indications For Surgerymentioning

confidence: 99%

External choledochoduodenostomy. An evaluation of 125 cases

Wm¹

1961

Journal of British Surgery

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“…Bergh (1942a, b) showed that a fatty meal produced relaxation of the sphincter of Oddi and that this effect was not dependent on the presence of the gallbladder. Doubilet (1958a) has stated that a fatty meal following an attack of pancreatitis is a common cause of a severe recurrence. According to Mallet-Guy (1965) dystonia of the sphincter is a cause of pancreatitis; out of 150 cases in which dystonia was demonstrated by radiological and manometric methods, 133 were regarded as hypotonic.…”

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confidence: 99%

“…Pancreatic juice from the inflamed pancreas has been found to contain a considerable amount of active proteolytic enzymes which tends to decrease as the patient recovers (Troll and Doubilet, 1951;Doubilet, 1958b). It has been claimed that serum proteolytic enzyme levels rise in pancreatitis while there is a concomitant fall in antifibrinolysin levels (Elliott et al, 1955;Nardi, 1958), but the demonstration of these enzymes in serum is difficult because of the presence of potent inhibitors (Dreiling, 1958).…”

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confidence: 99%

A fresh approach to the pathogenesis of pancreatitis.

McCutcheon¹

1968

Gut

129

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“…We envisage that this procedure would more closely imitate a mechanism believed to play a pathogenic role in human pancreatitis -that is, reflux of duodenal con tents into the ducts [23]. Solutions, introduced retrograde into the gland under pressure, gain access to the interstitial connective tissue through the intercellular spaces of the acinar, ductular and/or ductal epithelium [12,13]. Since these solutions contain trypsin and chymotrypsin, they cause destruction of the pancreatic tissues by enzymatic digestion, thus initiating the inflammatory response.…”

Section: Discussionmentioning

confidence: 99%

Factors in the Pathogenesis of Experimental Acute Pancreatitis in the Rat

Durst¹,

Dishon²,

Rosenmann³

et al. 1973

Eur Surg Res

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This is a study of the injurious effects of transient reflux of diverse solutions when introduced into the pancreas of rats under pressure through the obstructed duodenum. Mild pan Immune complex disease creatitis resulted from introduction of saline. Administration of homologous or heterologous proteinaceous solutions induced moderate pancreatitis; prior sensitization of the animals to the respective protein did not aggravate the inflammatory process. Severe pancreatitis developed after intraduodenal injection of nephrotoxic serum (basement membrane antibodies) or preformed immune complexes. It is suggested that pancreatitis ensues as a result of reflux of solutions carrying activators of trypsinogen from the duodenum into the ducts at a time when pancreatic secretion is enhanced by intestinal hormones. Pancreatic damage results from passage of the activated enzymes across the acinar and ductular epithelium into the interstitial tissue. The severity of the pancreatitis is augmented when immune mechanisms are superimposed. An attempt at demonstrating organ-specific antigens in the urine of rats with pancreatitis was unsuccessful.

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The Physiological Basis for the Surgical Management of Acute and Chronic Pancreatitis

Cited by 18 publications

References 8 publications

External choledochoduodenostomy. An evaluation of 125 cases

External choledochoduodenostomy. An evaluation of 125 cases

A fresh approach to the pathogenesis of pancreatitis.

Factors in the Pathogenesis of Experimental Acute Pancreatitis in the Rat

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