While
pancreaticoduodenectomy is reported to be successful in certain patients with symptomatic recurrent or
chronic pancreatitis, there are few criteria indicating who will benefit from such an extensive operation. This report consists of a small group of well-defined patients with recurrent episodes of
alcoholic pancreatitis who benefited from
pancreaticoduodenectomy. The courses of each patient were remarkably similar--recurrent episodes of
pancreatitis,
weight loss, epigastric
pain, intermittent
fevers, persistently elevated serum
amylase and leukocyte counts, negative blood cultures, intermittent
jaundice, failure of endoscopic retrograde cholangiopancreatography and scans showing a persistent mass in the head of the pancreas and biliary obstruction. While no patient had evidence of
abscess at elective operation, all had multiple microscopic
abscesses, apparently localized to the enlarged pancreatic head. Such localized microabscesses are not necessarily associated with acute
clinical deterioration, positive blood cultures, cannulation of the pancreatic duct or pancreatic ductal dilatation. All patients benefited from operation. The presentation of recurrent episodes of
pancreatitis associated with persistent enlargement of the pancreatic head and biliary obstruction without relentless progression of
jaundice suggests that the patient will benefit from
pancreaticoduodenectomy.