Treatment of chronic pancreatitis by longitudinal pancreaticojejunostomy

Silen, William; Baldwin, John C.; Goldman, Leon

doi:10.1016/0002-9610(63)90014-x

Cited by 20 publications

(5 citation statements)

References 22 publications

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“…Multiple points of obstruction give the 'chain of lakes' appearance and drainage operations afford considerable relief from pain (DuVal, 1954;Silen, Baldwin, and Goldman, 1963). The major site of obstruction is several centimetres from the duodenum and not at the ampulla of Vater.…”

mentioning

confidence: 99%

A fresh approach to the pathogenesis of pancreatitis.

McCutcheon¹

1968

Gut

129

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mentioning

confidence: 99%

A fresh approach to the pathogenesis of pancreatitis.

McCutcheon¹

1968

Gut

129

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“…82,83 2. In 1 patient with AP treated by lateral pancreaticojejunostomy, thick material resembling toothpaste occluded the large and small PDs 84 and there are similar reports of ducts filled with inspissated fluid, without any stones, in patients with acute pancreatitis. 76,[85][86][87] 3.…”

Section: Relation To Protein Plugsmentioning

confidence: 69%

Neurological Damage and Duodenopancreatic Reflux in the Pathogenesis of Alcoholic Pancreatitis

McCutcheon

2000

Arch Surg

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To present a new theory on the pathogenesis of acute alcoholic pancreatitis based on experimental data, the significance of which has not been recognized, and on evidence from the current literature.Hypothesis: That chronic alcoholism damages muscarinic receptors in the pancreas, duodenum, and Oddi sphincter, producing heightened sensitivity to acetylcholine, stimulation of protein-rich pancreatic juice, hypertonicity of the duodenum and esophagus, relaxation of the Oddi sphincter, and intraduodenal pressures exceeding those shown to cause duodenopancreatic reflux and acute pancreatitis in humans and experimental animals.Outcome: The duodenopancreatic reflux mechanism can explain all of the clinical features of acute alcohol pan-creatitis, including the intraductal site and rapid activation of zymogens by enterokinase, the recurrent episodes of pancreatitis, the precipitation of protein plugs by partial proteolytic hydrolysis, the severe vascular changes, the relation to infection by the most direct route, and the progression to chronic pancreatitis via the necrosis-fibrosis sequence.Conclusions: Damage to the nervous system, with a time lag of 5 to 15 years between the onset of heavy drinking and the development of neurological disorders (peripheral neuropathy and cerebellar degeneration), is a characteristic complication of chronic alcoholism. The similarity to events in alcoholic pancreatitis is striking.

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“…The other commonly used procedure is lateral anastomosis between the main pancreatic duct and a loop of jejunum (Lempke et al, 1963;Silen et al, 1963). This operation, and partial pancreatectomy or pancreaticoduodenectomy, are major procedures that are technically difficult, and we would advise such operations only for patients with pancreatic stones as well as chronic pancreatitis.…”

Section: Discussion Chronic Pancreatitismentioning

confidence: 99%

“…Lempke et al (1963) and Silen et al (1963) performed lateral pancreaticojejunostomy for alcoholic chronic pancreatitis, and we would use this same procedure or a distal drainage operation for any patient whose chronic pancreatitis was complicated by pancreatic stones, in order to drain the pancreatic duct. One patient, not in this series, was so treated.…”

Section: Discussion Chronic Pancreatitismentioning

confidence: 99%