[Criteria of diagnostic evaluation and results of surgical treatment in chronic pancreatitis].

Abstract

Correct diagnostic evaluation of chronic pancreatitis pictures must of necessity be directed to recognition of recurrent and stable forms and identification of the pathogenetic cause of the clinical forms. This objective seems to be achieved more than satisfactions by the diagnostic protocol employed personally, the first stages of which include X-ray of the abdomen for the identification of possible pancreatic calcification, ultrasonography and computed axial tomography for the analysis of organ's morphology and structure, intestinal absorption and pharmacodynamic tests of the papillary excretory complex for the evaluation of functional state of the pancreas. At a second time, this diagnostic protocol includes endoscopic pancreatography for the analysis of the excretory duct and identification of possible calcareous concretions in its lumen, and district angiography, for information on the extreme viscero-vascular implications and the possibility of coexistence of district portal hypertension pictures. The resulting information dominates therapeutic choices by indicating the usefulness of performing a papillo-sphincteroplasty to handle the biliary aetiology in recurrent forms and Wirsung septoplasty for ductal ostial stenoses. The choice of shunts and resections is confirmed to the stable forms, with the use of the former in the event of ductal dilatation and of the latter in the absence of this and in the presence of more or less marked gland fibrosis. Derivative procedures also control treatment of chronic post-pancreatitis pseudocyst, with a clear-cut prevalence of cysto-gastric shunts over all the other possibilities.(ABSTRACT TRUNCATED AT 250 WORDS)