胰腺腺鳞癌9例临床分析

目的探讨胰腺腺鳞癌临床病理学特点和诊断治疗方法.方法回顾性分析9例经手术和病理证实的胰腺腺鳞癌的临床、手术及病理资料.结果本组共9例,77.8%(7/9)为老年患者,肿瘤位于胰头6例,胰体尾3例.主要的临床表现是黄疸和腹痛,CT提示胰腺低密度占位.8例获手术切除,1例行胆囊空肠襻式吻合术.病理检查:瘤体平均直径为4.5 cm,镜下表现为腺癌和鳞癌混杂.肿瘤侵犯十二指肠3例,侵犯肠系膜上静脉1例,侵犯脾静脉1例,侵犯胃1例,侵犯神经2例,淋巴结转移2例,肝转移1例.随访7例,术后生存3～17月,平均生存时间5.5月,均死于肿瘤复发和肝转移.结论胰腺腺鳞癌呈侵袭性生长,易侵犯周围脏器和远处转移,恶性程度高,预后差;临床症状和影像学表现无特异性,术前确诊困难;手术切除是有效的治疗手段.     

胰腺腺鳞癌9例临床分析

目的：探讨胰腺腺鳞癌临床病理学特点和诊断治疗方法。方法：回顾性分析9例经手术和病理证实的胰腺腺鳞癌的临床、手术及病理资料。结果：本组共9例,77．8％（7／9）为老年患,肿瘤位于胰头6例,胰体尾3例。主要的临床表现是黄疸和腹痛,CT提示胰腺低密度占位。8例获手术切除,1例行胆囊空肠襻式吻合术。病理检查：瘤体平均直径为4．5cm,镜下表现为腺癌和鳞癌混杂。肿瘤侵犯十二指肠3例,侵犯肠系膜上静脉1例,侵犯脾静脉1例,侵犯胃1例,侵犯神经2例,淋巴结转移2例,肝转移1例。随访7例,术后生存3－17月,平均生存时间5．5月,均死于肿瘤复发和肝转移。结论：胰腺腺鳞癌呈侵袭性生长,易侵犯周围脏器和远处转移,恶性程度高,预后差;临床症状和影像学表现无特异性,术前确诊困难;手术切除是有效的治疗手段。     

胰腺间变癌的临床病理特点--附6例报告

目的胰腺间变癌是少见的胰腺外分泌恶性肿瘤,本文探讨其临床病理学特点.方法回顾性分析6例胰腺间变癌的临床特点并结合文献讨论.结果本组6例,其中男5例,女1例,年龄45～74岁.肿瘤位于胰头3例,胰体尾3例.行胰头十二指肠切除术3例,其中1例作肠系膜上静脉切除重建术,另1例同时行肠系膜上动、静脉切除重建术.3例胰体尾肿块,2例行胰体尾切除、脾切除术,另1例肿瘤已侵犯周围脏器,行全胃、结肠脾曲、腹腔动脉切除术.病理检查:肿瘤细胞呈多形性,可见圆形、卵圆形、多边形和梭形的肿瘤细胞,核大深染,异型明显,也可见巨核或多核的瘤巨细胞及破骨细胞样巨细胞.随访5例,术后平均生存5.5月,均死于肿瘤腹腔内和肝脏转移.结论胰腺间变癌组织学特点为肿瘤细胞的多形性,并可见巨核或多核的巨细胞或破骨细胞样巨细胞,呈侵袭性生长,易侵犯周围脏器、大血管和发生肝脏、淋巴结转移,恶性程度高,预后差.     

胰腺原发性腺鳞癌9例临床病理分析及文献回顾

目的分析胰腺原发性腺鳞癌的临床和病理学特点,以提高对该病的认识和诊治水平。方法对2012年11月至2013年3月本院收治的9例胰腺原发性腺鳞癌患者的临床病理学资料进行回顾性分析,同时对14篇有关腺鳞癌的文献报道进行复习。结果在9例胰腺原发性腺鳞癌中,肿瘤位于胰头部者3例,胰体尾部5例,胰颈体1例。肿瘤的平均直径为（4．17±1．52）cm;其中1例侵犯门静脉,1例侵犯胃窦黏膜,1例侵犯十二指肠,1例侵犯横结肠,1例侵犯左侧肾上腺包膜,4例伴有胰周淋巴结转移;获随访的8例中死亡1例,术后生存时间为1～5个月,平均3．0个月。结论胰腺原发性腺鳞癌是一种少见的胰腺恶性肿瘤,组织学上肿瘤由导管腺癌成分和鳞状细胞癌成分混合构成,其临床表现与胰腺导管腺癌相似。通过早期诊断与手术结合放射、化学治疗可提高疗效。     

胰腺腺泡细胞癌八例临床病理及免疫组化分析

目的 分析胰腺腺泡细胞癌的临床病理特征及蛋白表型.方法 收集2001年1月至2011年1月收治的8例胰腺腺泡细胞癌病例,分析其临床病理特征,采用免疫组化法检测肿瘤的蛋白表型,并进行随访.结果 8例胰腺腺泡细胞癌病例均为男性,中位年龄47岁.肿瘤位于胰头部和胰体尾部各4例,大小平均为4.5 cm×4.0 cm ×3.2 cm,切面灰黄、灰红色,呈实性或囊实性,体积较大者常伴有出血、坏死.镜下见肿瘤细胞排列呈腺泡状、梁索状或实性片巢状,胞质丰富、嗜酸性,核圆形、卵圆形,轻度异型.免疫组化显示癌细胞低分子量细胞角蛋白(CAM5.2)、α1-抗胰蛋白酶(α1-AT)、抗胰糜蛋白酶(α1-ACT)蛋白表达呈弥漫阳性,CA19-9、CEA,上皮型钙粘蛋白(E-cad)、β-连环素(β-cat)和粘蛋白-1( MUC-1)呈灶性阳性,AFP、神经特异性烯醇化酶(NSE)、突触素(Syn)和铬粒素A(CgA)仅少数瘤细胞呈阳性表达.7例获得随访,1例因术后胰漏伴腹腔感染病死,发生肝转移4例,其中2例病死.结论 胰腺腺泡细胞癌是一种少见的胰腺上皮源性恶性肿瘤,有其特征性的蛋白表型.     

胰腺神经内分泌癌28例CT表现

目的 探讨胰腺神经内分泌癌的CT影像学特征.方法 回顾性分析28例胰腺神经内分泌癌的CT表现,观察肿瘤位置、瘤体直径、内部结构、强化方式、胰胆管改变、淋巴结及远处脏器转移情况等影像学征象.结果 24例为单发,4例为多发(胰腺内均可见2个病灶),共有32个病灶,形态多呈结节状或团块状.其中18个病灶位于胰尾,10个位于胰头,2个位于胰体,2个位于胰体尾交界部.位于胰头的病例中有5例胰管扩张,1例胆管扩张,2例胰胆管均扩张,2例胰胆管无明显改变.瘤体直径1.0 ～20.0 cm,平均5.1 cm,其中直径＜2cm 1个,2～5 cm 23个,＞5 cm8个.增强后病灶均不同程度强化,强化峰值多位于胰腺期.23个病灶侵犯邻近血管或脏器,5例有淋巴结转移,6例发生远处转移.结论 胰腺神经内分泌癌的CT表现具有一定的特异性,结合临床资料,做出术前诊断可能性较大.     

胰腺间变癌的临床病理特点——附6例报告

目的胰腺间变癌是少见的胰腺外分泌恶性肿瘤，本文探讨其临床病理学特点。方法回顾性分析6例胰腺间变癌的临床特点并结合文献讨论。结果本组6例，其中男5例，女1例，年龄4j～74岁。肿瘤位于胰头3例，胰体尾3例。行胰头十二指肠切除术3例，其中1例作肠系膜上静脉切除重建术，另1例同时行肠系膜上动、静脉切除重建术。3例胰体尾肿块，2例行胰体尾切除、脾切除术．另1例肿瘤已侵犯周围脏器，行全胃、结肠脾曲、腹腔动脉切除术。病理检查：肿瘤细胞呈多形性．可见圆形、卵圆形、多边形和梭形的肿瘤细胞，核大深染，异型明显，也可见巨核或多核的瘤巨细胞及破骨细胞样巨细胞。随访5例，术后平均生存5．5月．均死于肿瘤腹腔内和肝脏转移。结论胰腺间变癌组织学特点为肿瘤细胞的多形性，并可见巨核或多核的巨细胞或破骨细胞样巨细胞．呈侵袭性生长，易侵犯周围脏器、大血管和发生肝脏、淋巴结转移，恶性程度高，预后差。     

胰腺腺鳞癌的临床诊治分析

目的 总结胰腺腺鳞癌临床诊治经验,以提高对该病的认识和诊治水平.方法 对2002年7月至2008年6月我院收治的5例胰腺腺鳞癌患者的临床资料进行回顾性分析,并结合文献讨论.结果 本组5例胰腺腺鳞癌患者,其中男3例,女2例,平均年龄(64±18)岁.肿瘤位于胰头部者2例,位于胰体尾部者3例;行胰头十二指肠切除术1例,行胰体尾、脾脏切除术3例,行胆肠+胃肠双旁路内引流术并~(125)Ⅰ粒子植入1例.肿瘤平均长径4.5 em,1例侵犯胃后壁、十二指肠降部、门静脉,2例侵犯脾门处包膜,2例合并有神经、血管侵犯,1例伴有淋巴结转移.组织学特征为腺癌和鳞癌成分混杂在一起,呈浸润性生长.5例均获随访,3例死于肿瘤复发和肝转移,术后生存8.5～13.5个月,平均11.2个月,2例已生存6个月和56个月.结论 胰腺腺鳞癌好发年龄60岁左右,临床确诊较困难,恶性程度高,预后差,手术切除结合放、化疗的综合治疗可提高疗效.     

应用高强度聚焦超声治疗老年人胰腺癌19例

我们用高强度超声聚焦(HIFU)治疗了19例老年人胰腺癌患者,并取得了较好的近期疗效,现报告如下. 1对象和方法 1.1对象19例中男12例、女7例;年龄61～79岁,平均年龄71.3岁.原发性胰腺癌17例、转移性胰腺癌2例.肿瘤部位:胰头癌7例,胰体尾癌12例.肿瘤体积最大为11cm×8 cm×6 cm,最小为3 cm×3 cm×2 cm.所有患者均未接受手术、放疗等治疗;7例患者接受过化疗,均无效.     

游离肠系膜上动脉对提高胰腺钩突癌切除彻底性的临床意义

目的 观察游离肠系膜上动脉、切除肠系膜根部的扩大胰十二指肠切除术对累及肠系膜根部胰腺钩突癌的手术效果.方法 2004年1月至2007年12月为23例(男14例,女9例,年龄30～72岁)累及肠系膜根部的胰腺钩突癌患者施行了合并游离肠系膜上动脉、切除肠系膜根部的扩大胰十二指肠切除术,对手术方法 、手术安全性及手术疗效进行分析.结果 12例患者施行了肠系膜根部切除的扩大胰十二指肠切除术,11例同时施行了肠系膜上静脉的切除和重建.平均手术时间(4.2±1.1)h,术中出血量(1 635±1 362)ml,术中输血量(1 609±1 462)ml.全组患者无手术死亡,6例出现轻至重度腹泻,术后住院天数9～30 d.病理示,肿瘤直径3～8 cm,合并淋巴结转移13例(57%),神经浸润20例(87%),22例手术切缘均为阴性,11例血管切除患者中有10例血管内膜浸润.随访5～42个月,4例发生肝转移,3例局部复发,1年、2年的累积生存率分别为77.2%和42.5%.结论 通过游离肠系膜上动脉,对肠系膜根部组织、肠系膜上动脉周围神经以及广泛后腹膜组织的切除可以提高胰十二指肠切除术治疗胰腺钩突癌的手术彻底性,有效降低肿瘤残留,减少局部复发.手术方法 是安全的.     

胰腺癌的不典型64排螺旋CT影像表现

目的 分析胰腺癌的64排螺旋CT的不典型表现,以提高对该肿瘤的CT征象的认识水平.方法 回顾性分析经手术病理证实的缺乏典型CT征象的12例胰腺导管腺癌的64排螺旋CT资料.结果 12例均为胰腺导管腺癌.其中,中分化导管腺癌7例,中高分化导管腺癌1例;黏液腺癌1例;腺鳞癌3例.8例导管腺癌病灶中位于胰头及(或)钩突部7例,胰颈部1例,表现为等、低密度或囊实性肿块,增强后无明显强化;5例肿瘤呈明显外生性或有外生倾向;5例肿瘤远端胰管无扩张,2例出现胆总管和肝内胆管扩张,仅1例出现肿瘤远端胰腺萎缩.1例黏液腺癌CT平扫示胰头部5 cm囊性病灶,增强后仅囊性病灶下方少许实性部分轻度强化,体尾部胰管中度扩张(7 mmn),胆总管及邻近血管未受侵犯.3例腺鳞癌病灶中位于胰头2例,胰体部1例,肿块最大径3.0～4.5 cm,CT增强扫描胰腺实质期示3例病灶内均见液化坏死区,病灶远端胰管均轻度扩张(4～5 mm),胆总管和肝内胆管均未见扩张.结论 胰腺癌可出现不典型的CT影像表现,要注意与易混淆疾病进行鉴别诊断.     

Intraductal polypoid growth variant of pancreatic acinar cell carcinoma metastasizing to the intrahepatic bile duct 6 years after surgery: A case report and literature review

We present the first reported case of intraductal polypoid growth (IPG) variant of pancreatic acinar cell carcinoma (ACC) metastasizing to the intrahepatic bile duct. A 58-year-old Japanese woman had previously presented with obstructive jaundice and a 7.0 cm mass in the pancreatic head. She underwent biliary drainage for 2 months followed by pancreatectomy. Histological examination revealed a carcinoma with acinar pattern, immunohistochemically positive for trypsin, and acinar cell carcinoma was diagnosed. IPGs were prominent in the main pancreatic duct and its tributaries, extending into the intrapancreatic bile duct with tumor casts in the lumen. Imaging examinations 6 years later revealed a growing lesion within the intrahepatic bile duct. Needle biopsy examination suggested metastasis of ACC, and she underwent chemoradiation therapy and partial hepatectomy. Histological examination demonstrated ACC confined to the intrahepatic bile duct. The localization of metastasis and slow growth may indicate indolent biologic behavior of the IPG variant.     

The posterior approach in pancreaticoduodenectomy: preliminary results

BACKGROUND/AIMS: We present our technical version of pancreaticoduodenectomy by posterior approach that enables a complete dissection of the right side of the mesenteric superior artery and of the portal vein, as well as a complete excision of the retroportal pancreatic process (or lamina), and report the preliminary outcomes of the first 10 selected patients. METHODOLOGY: Between 1 December 2005 and 1 March 2006 10 patients (7 males and 3 females) with a mean age of 60.6 years (range 45-81 years) were operated on using this technique. The patients were diagnosed with carcinoma of the pancreatic head (8 cases), ampullary carcinoma (1 case), and carcinoma of the distal part of the common bile duct (1 case). Invasion of the portal vein occurred in 2 of the 8 cases of carcinoma of the pancreatic head. RESULTS: No significant intraoperative incident was recorded. The mean operative time was 225 minutes (ranging between 180 and 240 minutes) and the mean blood loss was 372,25cc (range 150-800cc). Two cases of carcinoma of the pancreatic head that had a segmental resection of the portal vein needed vascular reconstruction which was performed by Goretex graft interpositing. The pylorus-preserving procedure was used in 2 cases (ampullary carcinoma, and carcinoma of the distal part of the common bile duct, respectively). Postoperative complications consisted of intraabdominal hemorrhage from an arterial source of the pancreatic capsule (on the day of the operation necessitating reoperation for hemostasis) in one case, and pancreatic fistula (that required conservative treatment) in another case. No postoperative diarrhea, delayed gastric emptying episodes or postoperative deaths were recorded. There were no postoperative deaths. The mean length of hospitalization was 12.2 days (range 10-24 days). CONCLUSIONS: The posterior approach in pancreaticoduodenectomy offers an early selection of patients during the operation (in terms of resectability). As compared to the standard procedure, it enables an adequate lymphadenectomy that can be safely performed (by early dissection and isolation of the superior mesenteric artery), and avoids possible intraoperative accidents secondary to anatomical arterial abnormalities. This approach is particularly recommended in cases with portal vein invasion because it allows a "no-touch" resection.     

十二指肠乳头腺癌64例低张MSCTE的影像学特征分析

目的分析低张多层螺旋计算机断层扫描小肠造影(multi-slice computer tomography enterography,MSCTE)检查十二指肠乳头腺癌的影像征象及低张MSCTE对十二指肠乳头腺癌的诊断价值。方法回顾性分析经病理证实64例十二指肠乳头腺癌的影像学特征。结果64例患者中,57例十二指肠乳头腺癌体积较小(直径≤3 cm),3.1~4.0 cm 7例。形态的变化差异较大,47例形态规则,17例不规则。5例体积较大肿瘤内出现液化坏死,液化坏死区在动脉期和门脉期显示清晰,延迟期边界模糊。29例类圆形结节出现靶征,不仅在动脉期,门脉期、延迟期也会出现,病变在不同层面靶征可连续或不连续,其中2例靶征连续,27例靶征不连续。59例胆管呈软腾样扩张。32例胰管扩张,其中30例是胰胆管同时扩张,2例仅胰管扩张。32例胰管扩张中14例分支胰管扩张呈“多管征”,可清晰显示副胰管汇入副乳头。3例胰胆管同时不扩张。27例胆总管下端平直截断,14例呈鸟嘴样狭窄,8例见结节突入管腔呈杯口样充盈缺损。低张MSCTE术前判断27例十二指肠腺癌侵犯肠壁深肌层及浆膜层,8例侵犯胰腺,6例淋巴结转移,2例肝脏转移,2例分别并发胃癌、胆囊癌。结论低张MSCTE对十二指肠乳头腺癌直接征象、胰胆管扩张情况及其周围器官的组织显示具有特征性,可提高筛查率和诊断准确率。     

A case of acinar cell carcinoma of the pancreas that formed extensive tumor thrombus of the portal vein

A 58-year-old man was admitted to our hospital because of anorexia and back pain. He had been previously diagnosed with chronic pancreatitis with blood thrombus of the splenic vein at another hospital. Abdominal ultrasonography and computed tomography revealed a large mass in the body and tail of the pancreas, which directly invaded the stomach and the spleen. Small nodular metastases in both lungs were also detected. Furthermore, tumor thrombus continuously involved the splenic and proximal superior mesenteric vein, main portal vein, and its right intrahepatic branch. A metastatic mass was disclosed in the adjacent liver. The specimens obtained from portal tumor thrombus were histologically compatible with acinar cell carcinoma. Portal tumor thrombus is a rare condition in pancreatic tumors; however, it seems to be important to differentiate tumor thrombus from blood thrombus of the portal vein in order to know the true clinical stage and provide a suitable treatment.     

MSCT重建技术在胰腺癌术前评估中的应用

目的 探讨多层螺旋CT（MSCT）重建技术在胰腺癌手术可切除性评估中的应用价值.方法 回顾性分析35例经手术证实的胰腺癌患者的多期增强CT图像及包括容积重建（VR）、多平面重建（MPR）、曲面重建（CPR）等的后处理方法,重点观察胰腺肿瘤与周围结构、邻近血管、胆管的关系,进行肿瘤能否手术切除的评估,并与实际手术的结果进行对比.结果 35例患者中9例共27支血管受侵犯;19例总胆管、12例胰管受侵犯;7例十二指肠受侵,2例胃后壁受侵,1例脾肿大伴区域性门脉高压;14例次胰头周围淋巴结肿大,4例次腹主动脉旁淋巴结肿大,3例肝转移.CT术前评估手术可切除21例,最终19例行胰腺癌根治术,2例行姑息术;术前评估手术不可切除14例,均行姑息术.根治术、姑息术术前评估与术后结果符合率分别为90％、88％.结论 MSCT重建技术能提高对胰腺癌局部侵犯、转移的诊断,可提高对肿瘤可切除性的评估.     

Congenital cystic dilatation of the common bile duct, anomaly of the biliopancreatic junction and cancer of the bile ducts

The choledochus and pancreatic duct ordinarily enter the duodenum either separately or via a common channel located in the duodenal wall. The usual maximal length of the common channel is approximately 0.5 cm. An anomalous junction of the pancreaticobiliary tract is defined by the presence of an unusually long common channel whose length is 1 cm or longer. During the last 8 years, we studied 9 cases of congenital dilatation of the bile duct. Besides the choledochal cyst, all patients had a common channel which measured 1.5 cm or longer. The mean age of patients (6 females, 3 males) was 36.5 years. Three patients had extrahepatic bile tract carcinoma. One patient, a 51-year old man, had gallbladder carcinoma without stones while the two other patients, a 43-year old woman and a 32-year old man, had carcinoma arising from the wall of the cystic dilatation. These two patients had undergone a simple internal drainage procedure 16 and 8 years before, respectively. Our study suggests that the anomalous junction of the pancreaticobiliary tract, an embryonic anomaly which allows the reflux of pancreatic juice into the bile duct and gallbladder, may be responsible for congenital bile duct dilatation and biliary tract carcinoma. Total excision of the cystic dilatation and the gallbladder with hepaticojejunostomy is the appropriate surgical treatment.     

Involvement of the biliary system in autoimmune pancreatitis: a follow-up study.

BACKGROUND & AIMS: The aim of this study was to define the bile duct changes associated with autoimmune pancreatitis. METHODS: Eight patients with autoimmune pancreatitis were followed for a mean of 4 years. The clinical features of these patients, including extrapancreatic bile duct changes, were examined by using biochemical parameters and several imaging modalities. Pathologic features of the pancreas and liver were examined by using the biopsy specimens of 7 patients. RESULTS: Diffuse or focal narrowing of the main pancreatic duct was observed in all patients. Histologic examination of the pancreas showed lymphoplasmacyte infiltration with severe fibrosis and acinar cell depletion. In 6 patients extrapancreatic bile duct changes such as stricture of the bile duct at hilus or intrahepatic area were observed. In 2 patients abnormalities in the bile duct and pancreas were detected simultaneously at diagnosis, and changes in the bile duct were observed later in 4 patients. Lymphoplasmacyte infiltration and fibrosis were observed in the portal area of all 7 liver biopsy samples. Five of the patients with bile duct changes received steroid therapy, and the pathological changes improved. CONCLUSIONS: Extrapancreatic bile duct changes are frequently associated with autoimmune pancreatitis. Similar pathogenic mechanism might produce the biliary tract and pancreatic abnormalities in autoimmune pancreatitis resulting in a similar histopathology in the liver and pancreas and response to steroid therapy.     

Pancreatic carcinoma accompanied by pseudocyst: Report of two cases

Two cases of pancreatic cancer accompanied by pseudocyst are reported. Case 1 was a 60-year-old man who was admitted to our hospital complaining of left lower abdominal discomfort. A cystic lesion, about 3 cm in diameter, was found in the pancreatic tail by ultrasonography (US) and computed tomography (CT). No signs of chronic pancreatitis were found. At operation, an elastic, hard, white tumor, about 1 cm in diameter, was felt adjacent to the cystic lesion on the duodenal side. Histologically, this tumor was a duct cell carcinoma with an adjacent pseudocyst upstream of the pancreas. Case 2 was a 57-year-old man who complained of back pain and loss of body weight. US and CT examination revealed a cystic lesion, 11×7 cm in size, in the tail of the pancreas. Histological examination of the resected speciment revealed both a duct cell carcinoma, 3 cm in size, in the body of the pancreas and a pseudocyst, 9 cm in size. Pseudocysts accompanying carcinoma are thought to develop from obstruction of the pancreatic duct by the carcinoma, followed by intraductal high pressure and disruption of ductules upstream of the pancreas. Thus, we should pay careful attention to pseudocyst of the pancreas, especially when signs of diffuse chronic inflammation cannot be found, to help identify duct cell carcinoma in the early stage. Further detailed examinations of the cyst fluid or pancreatic juice, such as cytology, tumor marker determinations, or establishment of K-ras codon 12 mutation, are needed.     

Bile-induced acute pancreatitis in cats

The relationship between pancreatic duct pressure, bile, bacterial infection of bile, and the development of acute pancreatitis was studied in a feline model. The cat main pancreatic duct was perfused from the head to the tail of the gland with bile and/orEscherichia coli bacteria at basal pancreatic duct pressure (<10 cm H₂O) and at pancreatic duct pressure in the upper physiologic range (45 cm H₂O). Sterile bile and sterile control solution produced no inflammatory alterations at either pressure. Infected control solution caused a mild acute edematous pancreatitis under low and high pressure. Infected bile caused a severe acute edematous pancreatitis at basal duct pressure; at high pressure, additional focal acinar necrosis was observed in the majority of animals. Infected bile was found to raise basal pancreatic duct pressure by 30%. The other test solutions, which caused only mild inflammatory alterations of the pancreas, did not alter duct pressure. We conclude: (1) Bacterial infection is important for the initiation of acute pancreatitis in this model. (2) High physiologic duct pressure may result in the conversion of nondestructive forms of the inflammation to acinar necrosis. (3) Infected bile-induced increase in duct pressure is likely to result from compression of the duct lumen by the inflammatory edema of the gland.