Pancreaticoduodenectomy for recurrent alcoholic pancreatitis associated with microabscesses

While pancreaticoduodenectomy is reported to be successful in certain patients with symptomatic recurrent or chronic pancreatitis, there are few criteria indicating who will benefit from such an extensive operation. This report consists of a small group of well-defined patients with recurrent episodes of alcoholic pancreatitis who benefited from pancreaticoduodenectomy. The courses of each patient were remarkably similar--recurrent episodes of pancreatitis, weight loss, epigastric pain, intermittent fevers, persistently elevated serum amylase and leukocyte counts, negative blood cultures, intermittent jaundice, failure of endoscopic retrograde cholangiopancreatography and scans showing a persistent mass in the head of the pancreas and biliary obstruction. While no patient had evidence of abscess at elective operation, all had multiple microscopic abscesses, apparently localized to the enlarged pancreatic head. Such localized microabscesses are not necessarily associated with acute clinical deterioration, positive blood cultures, cannulation of the pancreatic duct or pancreatic ductal dilatation. All patients benefited from operation. The presentation of recurrent episodes of pancreatitis associated with persistent enlargement of the pancreatic head and biliary obstruction without relentless progression of jaundice suggests that the patient will benefit from pancreaticoduodenectomy.