Complications of chronic pancreatitis
- Steven D Freedman, MD, PhD
Steven D Freedman, MD, PhD
- Professor of Medicine
- Harvard Medical School
Chronic pancreatitis is an inflammatory condition that results in permanent structural changes in the pancreas, which can lead to impairment of exocrine and endocrine function. The clinical manifestations of this disorder include chronic abdominal pain and pancreatic exocrine and endocrine dysfunction. There may also be an association with pancreatic cancer. (See "Clinical manifestations and diagnosis of chronic pancreatitis in adults".)
In addition, chronic pancreatitis can be associated with a variety of complications. The most common are pseudocyst formation and mechanical obstruction of the duodenum and common bile duct; less frequent complications include pancreatic ascites or pleural effusion, splenic vein thrombosis with portal hypertension, and pseudoaneurysm formation, particularly of the splenic artery.
These complications of chronic pancreatitis and their management will be reviewed here. Other aspects of the treatment of chronic pancreatitis (principally pain and pancreatic insufficiency) are discussed separately. (See "Treatment of chronic pancreatitis".)
Pseudocysts develop in approximately 10 percent of patients with chronic pancreatitis. They develop as a result of ductal disruptions rather than from peripancreatic fluid accumulations that lead to pseudocyst formation in the setting of acute pancreatitis. Pseudocysts may be single or multiple, small or large, and can be located either within or outside of the pancreas. Most pseudocysts communicate with the pancreatic ductal system and contain high concentrations of digestive enzymes. (See "Walled-off pancreatic fluid collections (including pseudocysts)".)
The walls of pseudocysts are formed by adjacent structures such as the stomach, transverse mesocolon, gastrocolic omentum, and pancreas (image 1). The lining of pancreatic pseudocysts consists of fibrous and granulation tissue; the lack of an epithelial lining distinguishes pseudocysts from true cystic lesions of the pancreas. (See "Classification of pancreatic cysts".)
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