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Early morphological and functional changes in pancreas following necrosectomy for acute severe necrotizing
Charudatta Bavare1, Ramkrishna Prabhu, Avinash Supe
1Department of Surgical Gastroenterology, Seth G S Medical College and K E M Hospital, Mumbai 400 012, India.
Introduction:
Morphological and functional changes in the pancreas after surgical pancreatic necrosectomy have not been studied extensively.
Aims:
To study morphological changes in the pancreas, and exocrine and endocrine pancreatic function following pancreatic necrosectomy.
Methods:
Eighteen adult patients surviving at least one month after pancreatic necrosectomy for acute necrotizing pancreatitis were followed up. Contrast-enhanced computed tomography was done every six months. Stool fat was estimated at 3-month intervals, and need for and response to enzyme supplements were recorded. Blood sugar was measured every fortnight; in patients with hyperglycemia, need for oral hypoglycemic agents or insulin was recorded. Additional pancreatic imaging was done in some cases.
Results:
Six weeks after surgery, nine of 18 patients had exocrine insufficiency. Thirteen patients developed endocrine insufficiency, including 5 who also had exocrine insufficiency. At the end of the study, 13 patients had endocrine insufficiency and 2 had exocrine insufficiency. Pancreatic size was subnormal in all patients at the end of six months. Pancreatography in three cases did not reveal any ductal abnormality.
Conclusions:
Necrotizing pancreatitis affects pancreatic exocrine or endocrine function in more than half the patients.
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