Duodenal stenosis in chronic pancreatitis: clinicopathological correlations

Persistent duodenal stenosis has been noted as a complication of chronic pancreatitis, but its clinical importance and histologic basis have not been defined. We report three patients with chronic alcoholic pancreatitis who developed duodenal stenosis and intractable abdominal pain. In two patients, the stenosis was caused by severe inflammation of pancreatic tissue within the wall of the duodenum. Pancreaticoduodenectomy resulted in prompt and sustained clinical improvement in both patients. In the third patient, who had mural inflammation in the distal stomach and presumably in the duodenum as well, vagotomy and gastrojejunostomy relieved severe duodenal obstruction but not pain. This study supports the view that duodenal stenosis is caused by severe intramural duodenal inflammation and suggests that a pancreaticoduodenectomy may be required for relief of pain.