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Acute Pancreatitis Complicating Polya Gastrectomy

Acute Pancreatitis Complicating Polya Gastrectomy Abstract I read with interest the article titled "Recurrent Acute Pancreatitis Caused by Afferent Loop Stricture After Gastrectomy" by Mithöfer and Warshaw1 and would like to make the following comment. Contrary to what is stated by these authors, the mechanism by which afferent loop obstruction causes acute pancreatitis after a Polya gastrectomy is well established. A closed duodenal loop in dogs and rats produces severe acute pancreatitis that closely resembles clinical pancreatitis, and it results from the reflux of duodenal contents into the pancreatic duct.2,3 Wallensten4 recorded 12 deaths from pancreatitis after a Polya gastrectomy and attributed this to the occasional transformation of the afferent loop into a blind sac. Four similar, but nonfatal, cases were reported by Perman.5 The anatomical abnormality is basically the same as in the canine experiments, and little doubt exists that reflux of duodenal contents is responsible for causing acute pancreatitis in References 1. Mithöfer K, Warshaw AL. Recurrent acute pancreatitis caused by afferent loop stricture after gastrectomy . Arch Surg . 1996;131:561-565.Crossref 2. McCutcheon AD, Race D. Experimental pancreatitis: a possible etiology of postoperative pancreatitis . Ann Surg . 1962;155:523-531.Crossref 3. Kanao M, Nishiki M, Takasugi S, Kawanishi H, Ezaki H. Studies on pathogenesis of reflux pancreatitis . Hiroshima J Med Sci . 1984;33:731-737. 4. Wallensten S. Acute pancreatitis and hyperdiastasuria after partial gastrectomy . Acta Chir Scand . 1958;115:182-188. 5. Perman E. Surgical treatment of gastric and duodenal ulcer . Acta Chir Scand . 1935;38( (suppl) ):142. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Acute Pancreatitis Complicating Polya Gastrectomy

Archives of Surgery , Volume 132 (4) – Apr 1, 1997

Acute Pancreatitis Complicating Polya Gastrectomy

Abstract

Abstract I read with interest the article titled "Recurrent Acute Pancreatitis Caused by Afferent Loop Stricture After Gastrectomy" by Mithöfer and Warshaw1 and would like to make the following comment. Contrary to what is stated by these authors, the mechanism by which afferent loop obstruction causes acute pancreatitis after a Polya gastrectomy is well established. A closed duodenal loop in dogs and rats produces severe acute pancreatitis that closely resembles clinical...
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Publisher
American Medical Association
Copyright
Copyright © 1997 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1997.01430280126026
Publisher site
See Article on Publisher Site

Abstract

Abstract I read with interest the article titled "Recurrent Acute Pancreatitis Caused by Afferent Loop Stricture After Gastrectomy" by Mithöfer and Warshaw1 and would like to make the following comment. Contrary to what is stated by these authors, the mechanism by which afferent loop obstruction causes acute pancreatitis after a Polya gastrectomy is well established. A closed duodenal loop in dogs and rats produces severe acute pancreatitis that closely resembles clinical pancreatitis, and it results from the reflux of duodenal contents into the pancreatic duct.2,3 Wallensten4 recorded 12 deaths from pancreatitis after a Polya gastrectomy and attributed this to the occasional transformation of the afferent loop into a blind sac. Four similar, but nonfatal, cases were reported by Perman.5 The anatomical abnormality is basically the same as in the canine experiments, and little doubt exists that reflux of duodenal contents is responsible for causing acute pancreatitis in References 1. Mithöfer K, Warshaw AL. Recurrent acute pancreatitis caused by afferent loop stricture after gastrectomy . Arch Surg . 1996;131:561-565.Crossref 2. McCutcheon AD, Race D. Experimental pancreatitis: a possible etiology of postoperative pancreatitis . Ann Surg . 1962;155:523-531.Crossref 3. Kanao M, Nishiki M, Takasugi S, Kawanishi H, Ezaki H. Studies on pathogenesis of reflux pancreatitis . Hiroshima J Med Sci . 1984;33:731-737. 4. Wallensten S. Acute pancreatitis and hyperdiastasuria after partial gastrectomy . Acta Chir Scand . 1958;115:182-188. 5. Perman E. Surgical treatment of gastric and duodenal ulcer . Acta Chir Scand . 1935;38( (suppl) ):142.

Journal

Archives of SurgeryAmerican Medical Association

Published: Apr 1, 1997

References