What is Chronic Pancreatitis?

Chronic pancreatitis is persistent inflammation of the pancreas resulting in irreversible damage — fibrosis, calcification and ductal obstruction. The most common causes are alcohol use, tropical pancreatitis (hereditary) and autoimmune disease. It causes chronic abdominal pain, malabsorption (fatty stools), diabetes and nutritional deficiency.

Surgical Treatment

• Lateral Pancreaticojejunostomy (Puestow-Gillesby procedure) — the dilated pancreatic duct is opened longitudinally and drained into a loop of small intestine. Excellent pain relief in patients with a dilated main pancreatic duct (>6 mm).
• Frey's Procedure — combines ductal drainage with coring out of the pancreatic head. Preferred when there is a fibrotic pancreatic head mass causing duodenal or bile duct obstruction.
• Beger Procedure — duodenum-preserving pancreatic head resection for complex inflammatory head masses.
• Distal Pancreatectomy — for disease predominantly in the body and tail.
• Total Pancreatectomy with Islet Cell Autotransplantation (TPIAT) — in refractory cases at specialised centres.

Medical Management

• Pancreatic enzyme replacement therapy (PERT) — Creon with meals
• Pain management — analgesic ladder, coeliac plexus block for refractory pain
• Diabetes management — insulin therapy
• Nutritional support — fat-soluble vitamin supplementation
• Complete alcohol cessation — essential to slow disease progression