Plate 119
###### Figure 3

Drainage of the pancreatic duct by anastomosis to the jejunum may be indicated in the treatment of symptomatic chronic recurrent calcific pancreatitis. Before this procedure is carried out, all stones from the biliary tract should be removed by cholecystectomy and choledochostomy. There should be evidence of free drainage of bile through the papilla of Vater into the duodenum. Decompression of the obstructed pancreatic duct should be considered because of recurrent or persistent pain and evidence of progressive destruction of the pancreas.

All too often, these patients are addicted to alcohol and/or narcotics because of persistent pain. Evidence of advanced pancreatic disease may be diabetes, steatorrhea, and poor nutrition. The entire gastrointestinal tract should be surveyed with barium studies or endoscopy. The pancreatic and biliary systems are evaluated with ERCP and with dye study of both duct systems. Stones in the gallbladder or the common duct should be suspected, and ulceration of the duodenum is not uncommon. Evidence for or against gastric hypersecretion should be determined by secretion studies. The stools should be examined to determine the degree of pancreatic insufficiency, insofar as fats are concerned. Particular attention should be given to restoring the blood volume and controlling existing diabetes. Blood calcium and phosphorus levels should be determined to rule out a parathyroid adenoma.

General anesthesia is used.

The patient is placed supine on the table that is positioned for a cholangiogram or pancreatogram.

The upper abdomen is prepared in the usual manner.

A curved incision following the costal margin on the left and extending across the midline around to the right or a long midline incision, which may extend below the umbilicus on the left side, may be used. An upper midline incision may be used.

The stomach and duodenum should be evaluated thoroughly for evidence of an ulcer. Likewise, the gallbladder should be palpated carefully for evidence of stones, and the size of the common duct determined. In the presence of stones the gallbladder is removed and a cholangiogram is taken through the cystic duct. A small amount of contrast medium (5 mL) is first injected to avoid a dense shadow, which may hide small calculi in the common duct. Sufficient contrast medium should be injected subsequently to determine the patency of the papilla of Vater by visualization of the duodenum. It is advisable to carry out a Kocher maneuver to palpate the head of the pancreas, especially if there is radiographic evidence of an enlarged C-loop. Under such circumstances, needle aspiration may be carried out to search for evidence of a pancreatic cyst. ...

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

## Subscription Options

### AccessSurgery Full Site: One-Year Subscription

Connect to the full suite of AccessSurgery content and resources including more than 160 instructional videos, 16,000+ high-quality images, interactive board review, 20+ textbooks, and more.