Pancreatitis following operations on the stomach

Summary

Acute pancreatitis occurred in not less than one fifth of the patients after operations for stomach carcinoma, peptic ulcer, or polyposis of the stomach. Various chronic affections of the pancreas served as a favorable background for the development of postoperative pancreatitis. It is recommended to determine the pancreatic enzymes in the serum and in the urine of all the patients subjected to operations on the stomach to diagnose pancreatitis and for timely conservative treatment. This proved to be effective in many cases. Determinations may be limited to a urine amylase test, values exceeding 500 to 1,000 Wohlgemuth units being characteristic of postoperative pancreatitis. Blood glucose and calcium levels should be determined in gravely ill patients in order not to miss necrosis of the pancreas in which the enzyme level is often normal.

The clinical picture of postoperative pancreatitis is peculiar. Pains are not intensive or are absent entirely. The disease may follow the course under the mask of cardiovascular insufficiency, prolonged intestinal paresis, etc.

Injury of the pancreas, stasis in the duodenal stump, accidental ligation of pancreatic ducts or vessels supplying it, other vascular lesions, etc, may serve as causes of postoperative pancreatitis.