Evolution of lesions of the pancreatic duct following acute pancreatitis associated with a pseudocyst

AIMS: After an episode of acute pancreatitis, there is usually no sequelae; nevertheless cases of ductal stenosis have been reported. The aim of our study was to evaluate the frequency of pancreatic duct lesions after acute pancreatitis complicated by pseudocyst. PATIENTS AND METHODS: Between 1983 and 2004, 67 patients were admitted for severe acute pancreatitis. Out of these 67 patients, 36 patients were excluded because of chronic pancreatitis (N=12), intraductal papillary mucinous tumors of the pancreas (N=3), carcinoma (N=2), cystadenoma (N=3), alcohol consumption > 40 g/d (N=6), post-traumatic acute pancreatitis (N=3), and a follow-up less than 12 months (N=7). RESULTS: A stenosis of the main pancreatic duct was observed in 52% (16/31) of patients. This stenosis was isolated in 100% of cases, complete for 69% of them (11/16) and associated with upstream dilatation in 69% of cases (11/16). Although the pseudocyst was located in the body of the pancreas in 7/31 cases (48%), the stenosis was located in the head in 9/16 cases (56%). The predictive criteria of pancreatic duct lesions were complications associated with pseudocyst: extra-luminal compression (P=0.01), and vascular thrombosis (P=0.02). CONCLUSION: After an episode of acute pancreatitis complicated by pseudocyst, pancreatic duct stenosis is observed in 52% of the cases. These results show that complete resolution of pancreatic abnormalities after acute pancreatitis is not achieved systematically.