Severe chronic relapsing pancreatitis.

Summary 1. Seven patients complaining of severe pain suggestive of chronic relapsing pancreatitis were not controlled by medical means and a laparotomy was performed. 2. Case I had normal findings at laparotomy and serves as a “contrast case.” In the 6 remaining cases chronic pancreatitis was confirmed. In one, wedge biopsy was performed distal to stenosis of the pancreatic duct with subsequent pancreatic leakage. Three cases were treated by distal pancreatectomy and Roux-en-Y pancreaticojejunal anastomosis 2 were rendered pain free and one succumbed 4 months after operation with pancreatic leakage. One case was treated by distal pancreatectomy and pancreatico-gastrostomy, with moderate relief of pain for six months. One case was treated by distal pancreatectomy and oversewing of the stump as the duct was not patent there was relief of pain but she died seven months later from an unrelated cause. 3. A regime is suggested by one of us (I.J.W.) for the management of patients with severe chronic relapsing pancreatitis unresponsive to medical treatment. This includes meticulous medical care both pre- and post-operatively and an operative pancreaticogram to reveal the state of the pancreatic duct system, thus enabling a rational operative approach to be planned. Needle biopsy of the pancreas may be of value and our experience indicates that this is hazardous only if performed distal to obstruction of the pancreatic duct. 4. Improved results in the treatment of this challenging disease will accrue from close co-operation between surgeon, physician, radiologist and pathologist.