Many disorders can cause inflammation of the pancreas. The most common causes are gallstones and alcohol use. After pancreatitis resolves, some people continue to have recurrent pancreatitis without an identifiable cause. This may be due to scarring that has occurred in the ducts from previous attacks or from the sphincter of Oddi dysfunction. Many patients may have success with pancreatic stenting, Botox, and/or papillotomy (see ERCP link).
After bought of pancreatitis, the pancreatic duct may disrupt releasing the secretions. These become walled-off and are known as pseudocysts. These have the risk of causing pain, bleeding, and obstruction. Often, they need to be drained. Drainage can be performed percutaneously (through the skin), endoscopically (through the duct or stomach wall), and surgically (to the stomach or intestine). There are advantages and disadvantages of these different techniques, and the procedure should be tailored to the particular scenario.
ex. Laparoscopic Pancreatic Pseudocyst Drainage
Some cases of pancreatitis can be very severe where some or all of the gland dies. The inflammation leads to leaking of fluid outside of the blood vessels and decreased perfusion of other organs. The immediate treatment is aggressive hydration. Infection can develop in the dead pancreas that further increases the mortality rate. Surgical intervention is usually required. Traditionally, a large, open incision is made, some of the dead pancreases are removed (debrided), and the abdomen is packed open for multiple, repeat debridements. Further fluid loss occurs through the open abdomen, and repeated surgeries lead to poor survival rates. Laparoscopic debridement of the pancreas may be performed through small incisions keeping the abdomen closed with less insult to the patient. Survival rates are much better compared to open debridement.
Cat Scan of Necrotic Pancreas (Necrotic Pancreas)
Necrotic Pancreas Visualized Laparoscopically
Laparoscopically Debrided Pancreas