Abdominal Radiology

, Volume 41, Issue 10, pp 1980–1996 | Cite as

Surgical approaches to chronic pancreatitis: indications and imaging findings

  • Nima Hafezi-Nejad
  • Vikesh K. Singh
  • Stephen I. Johnson
  • Martin A. Makary
  • Kenzo Hirose
  • Elliot K. Fishman
  • Atif Zaheer
Pictorial Essay

Abstract

Chronic pancreatitis (CP) is an irreversible, inflammatory process characterized by progressive fibrosis of the pancreas that can result in abdominal pain, exocrine insufficiency, and diabetes. Inadequate pain relief using medical and/or endoscopic therapies is an indication for surgery. The surgical management of CP is centered around three main operations including pancreaticoduodenectomy (PD), duodenum-preserving pancreatic head resection (DPPHR) and drainage procedures, and total pancreatectomy with islet autotransplantation (TPIAT). PD is the method of choice when there is a high suspicion for malignancy. Combined drainage and resection procedures are associated with pain relief, higher quality of life, and superior short-term and long-term survival in comparison with the PD. TPIAT is a reemerging treatment that may be promising in subjects with intractable pain and impaired quality of life. Imaging examinations have an extensive role in pre-operative and post-operative evaluation of CP patients. Pre-operative advanced imaging examinations including CT and MRI can detect hallmarks of CP such as calcifications, pancreatic duct dilatation, chronic pseudocysts, focal pancreatic enlargement, and biliary ductal dilatation. Post-operative findings may include periportal hepatic edema, pneumobilia, perivascular cuffing and mild pancreatic duct dilation. Imaging can also be useful in the detection of post-operative complications including obstructions, anastomotic leaks, and vascular lesions. Imaging helps identify unique post-operative findings associated with TPIAT and may aid in predicting viability and function of the transplanted islet cells. In this review, we explore surgical indications as well as pre-operative and post-operative imaging findings associated with surgical options that are typically performed for CP patients.

Keywords

Chronic pancreatitis Pancreaticoduodenectomy Duodenum-preserving pancreatic head resection Total pancreatectomy Islet autotransplantation Imaging 

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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Nima Hafezi-Nejad
    • 1
  • Vikesh K. Singh
    • 2
    • 3
  • Stephen I. Johnson
    • 1
  • Martin A. Makary
    • 4
  • Kenzo Hirose
    • 4
  • Elliot K. Fishman
    • 1
  • Atif Zaheer
    • 1
    • 2
  1. 1.The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical InstitutionsJohns Hopkins UniversityBaltimoreUSA
  2. 2.Pancreatitis CenterJohns Hopkins Medical InstitutionsBaltimoreUSA
  3. 3.Division of GastroenterologyJohns Hopkins Medical InstitutionsBaltimoreUSA
  4. 4.Department of SurgeryJohns Hopkins HospitalBaltimoreUSA

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