Acute biliary pancreatitis: sphincter of Oddi and choledochal pressure

Twenty four patients with biliary pancreatitis were divided into three groups: A (18 subjects underwent surgery on the biliary tract seven days after admission to hospital when acute signs disappeared); B (3 cases were operated two months later), and C (3 patients underwent emergency surgery for acute cholescistitis with simultaneous acute pancreatitis). A cholecistectomy-choledochostomy through a Kehr tube was performed in all patients. Pressure in the main biliary duct (MBD) was measured. Only group A was significant (18 cases). As a control, another group, group D was considered (52 biliary cholecysto-choledochal lithiasis patients without pancreatitis and without transduodenal sphincterotomy). Group A: 1) The mean pressure in MBD on the fourth postoperative day (11 days after onset of pancreatitis) was low (p < 0.0001) in relation to that of group D with Oddi's sphincter (SO) normal; 2) in group A, no significant differences (p-NS) were found in relation to positions: during fasting, 4.4 +/- 4 cm H2O in the upright position, and 5.3 +/- 2 when lying (in group D, 9.9 +/- 4.1 cm H2O upright, and 7.76 +/- 3.6 lying with p = 0.0001), and 3) a slow improvement of pressure was observed and, on the 25th day after operation, it was nearly normal (9 cm H2O upright and 7 cm lying with p < 0.001). Group B: biliary surgery at 2 months; mean pressure in MBD meartly normal. Group C: 1) 4 days after emergency surgery, the pressure in MBF (15 cm H2O upright and 11.7 lying) was higher than in subjects with normal SO, probably due to compression of the distal part of MBD by the inflamed pancreas, and 2) from the 11th day the pressure followed the same evolution as that of group A. In conclusion, in patients with acute biliary pancreatitis, operated on the biliary tract when acute signs disappeared, MBD pressure is low (p < 0.0001) in reference to normal on the fourth post-operatory day (11 days after onset of pancreatitis) and no significant differences were found in relation to positions (upright and lying). The pressure changes are transient (4-5 weeks) and most probably due to the lesions and malfunction of the SO related to pancreatitis.