Obstructive pancreatitis is one form of chronic pancreatitis and as the name suggests, it could be due to an obstruction of its own or the common outlets of pancreatic drainage. The condition is considered to be a continuous process with irreversible morphological changes. Thus, unless the cause for the obstruction can be corrected and the inflammation controlled, the condition can lead to pancreatic failure, liver failure and even towards kidney disease.
What are the causes of obstructive pancreatitis?
As mentioned earlier, the causes of obstructive pancreatitis are partial or total blockage of the drainage of pancreatic juice. This can take place inside the pancreas within the pancreatic duct, within the distal portion of the common bile duct which drains both pancreatic juice as well as bile, and at the opening of the common bile duct into the duodenal portion of the small intestine.
One common reason for chronic obstructive pancreatitis is the presence of a ‘gall stone’ at the distal end of the common bile duct, blocking the flow of both the bile as well as the pancreatic juice. Thus, stagnating juices within the pancreas can lead to auto-digestion and therefore to a state of inflammation. As the inflammation continues, it can give rise to tissue damage and healing which may ultimately result in fibrosis. By this time, the changes taking place in the pancreas would be irreversible.
Another reason for such obstruction is the presence of a benign or malignant tumor. These can press against the pancreatic duct or its outlet and cause blockage and therefore gives rise to obstruction. A pseudocyst is another cause for obstructive pancreatitis which usually takes place within the pancreatic tissue substance or in the duodenal wall.
In certain instances, the cause for blockage may be the dysfunction of the sphincter mechanisms existing at the distal ends of the pancreatic duct as well as in the common bile duct. Such dysfunctions may affect the flow of the juices and cause back pressure that may damage the pancreatic tissues.
For those who have suffered from several attacks of acute pancreatitis, surgical interventions in the region or other causes of pancreatitis, stricture formation or gradual narrowing of the pancreatic duct could be the reason for its blockage.
What investigations can verify an obstructive pancreatitis?
In order to make an accurate diagnosis, clinicians have to combine multiple investigative approaches. These will include CT imaging, blood tests, and endoscopic evaluations, as well as histological assessments.
A technique known as Endoscopic Retrograde Cholangio Pancreatography (ERCP) has been widely used to assess the patency of the ductal system of the pancreas and the bile system, which can often point out the blockages and the distal dilations as well as the presence of potential tumors. However, these need to be verified using histological evaluation and imaging studies.
What are the available treatment options?
The treatment of chronic pancreatic disease, as in the case of obstructive pancreatitis, will be multimodal and long-term. In most instances, if doable, surgical relief of the obstruction should be undertaken after assessing the risks and the benefits to the patient.
In most instances, endoscopic resection, stent placement and sphincterotomy could be performed if the cause can be identified correctly. However, when the cause is a pancreatic cancer, surgery may not be an option or the outcome of such surgeries may not be effective.
Behavioral modifications should also help these patients and avoiding alcohol intake and dietary modifications should be of value in reducing the ongoing inflammatory process.
