Abstract
This article describes the surgery of tropical pancreatitis as practiced in a region of high incidence, based on the experience at 2 centers: the Department of Surgical Gastroenterology and Proctology, Government General Hospital, Madras, Tamilnadu (a tertiary-care referral unit) where 52 patients were diagnosed and 40 were operated on between 1982 and 1987; and the Department of Gastroenterology, Deva Matha Hospital, Koothattukulam (a specialized center located in the main endemic area of Kerala), where 116 patients were diagnosed and 33 operated on between 1983 and 1988. The latter series is described in detail with emphasis on the preoperative imaging, operative findings, surgical procedures, complications, and results of surgery.
The experience of other centers in southern India is summarized and discussed. The disease is obviously different from chronic pancreatitis in the West. Special problems of tropical pancreatitis, particularly the management of diabetes and the association of pancreatic carcinoma at a young age, are discussed.
Résumé
Cet article décrit la chirurgie de la pancréatite tropicale telle qu'on la pratique dans une région à incidence élévée et basée sur l'expérience de 2 centres: le Département de Gastroentérologie et Proctologie Chirurgicale de l'Hôpital Général du Gouvernement à Madras, Tamilnadu, où on trouve 52 patients avec la maladie et dont 40 ont subi une intervention entre 1982 et 1987, et le Département de Gastroentérologie de l'Hôpital Deva Matha, à Koothattukulam, centre spécialisé dans la région endémique de Kerala; on y a fait le diagnostic chez 116 patients dont 33 ont été opérés entre 1983 et 1988. La dernière série est décrite en détails pour mettre l'accent sur l'imagerie préopératoire, les données opératoires, les procédés chirurgicaux, les complications et les résultats de la chirurgie.
On passe en revue et on discute l'expérience des autres centres au Sud de l'Inde. La maladie pancréatique est manifestement différente de celle qu'on observe en Occident. On discute less problèmes spécifiques de la pancréatite tropicale, en particulier le traitement du diabète et l'association au cancer pancréatique à un âge jeune.
Resumen
El presente artículo describe el tratamiento quirúrgico tal como es practicado en una región de elevada incidencia, con base en 2 centros de la India, el Departamento de Gastroenterología Quirúrgica y Proctología del Government General Hospital, Madras (una unidad de referencia de nivel terciario) donde fueron diagnosticados 52 pacientes y 40 fueron operados entre 1982 y 1987; y el Departamento de Gastroenterología del Deva Matha Hospital, Koothattukulam (un centro especializado ubicado en la principal área endémica de Kerala) donde 116 pacientes fueron diagnosticados y 33 operados entre 1983 y 1988. La última de estas series es descrita en detalle con énfasis en la imagenología preoperatoria, los hallazgos operatorios, los procedimientos quirúrgicos, las complicaciones, y los resultados de la cirugía.
La experiencia de otros centros de la India es discutida y aparece resumida en este artículo. La enfermedad es obviamente diferente de la pancreatitis crónica comunmente observada en los países occidentales. Se revisan los problemas especiales que se asocian con la pancreatitis tropical, especialmente en lo relativo al manejo de la diabetes y la relación con el carcinoma pancreático en pacientes jóvenes.
Similar content being viewed by others
References
Pitchumoni, C.S.: Special problems of tropical pancreatitis. Clin. Gastroenterol.13:941, 1984
Koo, J., Ong, G.B.: Pancreatitis in India and the Orient. In Surgical Diseases of the Pancreas, J.M. Howard, G.L. Jordan, H.A. Reber, editors, Philadelphia, Lea and Febiger, 1987
Kini, M.G.: Multiple pancreatic calculi with chronic pancreatitis. Br. J. Surg.25:705, 1938
Mohan Rau, U.: Spontaneous resorption of pancreatic calculi. Indian J. Surg.18:471, 1956
Mahadevan, R.: Pancreatic lithiasis: A follow up study of 17 cases. Br. Med. J.1:626, 1961
Geevarghese, P.J.: Pancreatic Diabetes: A Clinicopathological Study of Growth Onset Diabetes with Pancreatic Calculi, Bombay, Popular Prakashan, 1968
Abraham, P.A.: Pancreatic lithiasis. Indian J. Surg.31:588, 1969
Bahuleyan, C.K.: Splanchnicectomy in pancreatic calculi. Indian J. Surg.38:188, 1976
Varghese, M.: Surgery in pancreatic diabetes. In Secondary Diabetes: The Spectrum of the Diabetic Syndromes, S. Podolsky, M. Viswanathan, editors, New York, Raven Press, 1980
Rajan, N., Nayak, M.N., Shenoy, M.G., Pisharoti, R., Rao, B.H.A.: Clinical profile of chronic pancreatitis in Manipal, South India. In Chronic Pancreatitis in India, V. Balakrishnan, editor, Trivandrum, St. Joseph's Press, 1987
Thomas, P.G., Augustine, P.: Surgery in tropical pancreatitis. Br. J. Surg.75:161, 1988
Cook, G.C.: Tropical Gastroenterology, New York, University Press, 1980, pp. 195–199
Nwokolo, C., Oli, J.: Pathogenesis of juvenile pancreatitis syndrome. Lancet1:59, 1980
Olurin, E.O., Olurin, O.: Pancreatic calcification: A report of 45 cases. Br. Med. J.4:534, 1969
Thomas, P.G., Augustine, P.: Pancreatic cancer in siblings with tropical pancreatitis. Indian J. Gastroenterol.6:185, 1987
Shenoy, K.T., Narendranathan, M., Hariharan, M.: Tropical pancreatitis—Sequelae and complications—A prospective study. In Proc. of the Annual Conference of the Indian Soc. of Pancreatology, V. Balakrishnan, K.R. Thankappan, editors, Trivandrum, Medical College Trivandrum, 1986
Sarles, H.: Epidemiology and physiopathology of chronic pancreatitis and the role of pancreatic stone protein. Clin. Gastroenterol.13:895, 1984
Bank, S.: Chronic pancreatitis: Clinical features and medical management. Am. J. Gastroenterol.81:153, 1986
Sarles, H.: Etiopathogenesis and definition of chronic pancreatitis. Dig. Dis. Sci.31:91s, 1986
Sarner, M., Cotton, P.B.: Classification of pancreatitis. Gut25:756, 1984
Lankisch, P.G., Otto, J., Erkelenz, I., Lembcke, B.: Pancreatic calcifications: No indicator of severe pancreatic insufficiency. Gastroenterology90:617, 1986
Balaraman, N.M., Latha, P.: Pancreas in chronic calcific pancreatitis. In Chronic Pancreatitis in India, V. Balakrishnan, editor, Trivandrum, St. Joseph's Press, 1987
Isaksson, G., Ihse, I.: Pain reduction by an oral pancreatic enzyme preparation in chronic pancreatitis. Dig. Dis. Sci.28:97, 1983
Venkatesh Rao, P.S.: The role of post coeliac neurectomy and surgical drainage in management of chronic pancreatitis, M.S. (General Surgery) Thesis, Christian Medical College, Vellore, Tamilnadu, 1983
Pain, J.A., Knight, M.J.: Pancreatogastrostomy: The preferred operation for pain relief in chronic pancreatitis. Br. J. Surg.75:220, 1988
Flautner, L., Tihanyi, T., Szécsény, A.: Pancreatogastrostomy: An ideal complement to pancreatic head resection with preservation of the pylorus in the treatment of chronic pancreatitis. Am. J. Surg.150:608, 1985
Williamson, R.C.N., Cooper, M.J.: Pain in chronic pancreatitis (Letter). Br. J. Surg.75:724, 1988
Shires, G.T., Warren, W.D., Millikan, W.J.: Denervated splenopancreatic flap for chronic pancreatitis. Ann. Surg.203:568, 1986
Cooper, M.J., Williamson, R.C.N., Benjamin, I.S.: Total pancreatectomy for chronic pancreatitis. Br. J. Surg.74:912, 1987
Gangadharan, P.: Epidemiology of cancer of the pancreas. In Proc. of the Annual Conf. of the Indian Soc. of Pancreatology, V. Balakrishnan, K.R. Thankappan, editors, Trivandrum, Medical College Trivandrum, 1986
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Thomas, P.G., Augustine, P., Ramesh, H. et al. Observations and surgical management of tropical pancreatitis in Kerala and Southern India. World J. Surg. 14, 32–42 (1990). https://doi.org/10.1007/BF01670542
Issue Date:
DOI: https://doi.org/10.1007/BF01670542