Acute pancreatitis following major pancreatic resection

Abstract

Postoperative (or postpancreatectomy) acute pancreatitis (PPAP) in the pancreatic remnant has recently been recognized as a distinct complication entity that may occur after both partial pancreatoduodenectomy (PD) and distal pancreatectomy (DP). However, it remains unclear what constitutes PPAP. Moreover, the pathophysiologic events leading to PPAP are not fully understood and no internationally accepted definition of PPAP exists. Recent studies mostly used an early postoperative increase of serum amylase above the institutional upper limit of normal to diagnose PPAP, but this resulted in exceptionally high PPAP rates exceeding 50% after PD and DP in those studies. To assume that more than 50% of those patients who had undergone PD or DP develop PPAP is at least questionable or may even be exaggerated. This article summarizes the current evidence on PPAP and on the diagnostic potential of postoperative pancreatic serum enzyme levels to identify patients suffering from PPAP.

Keywords

• Acute pancreatitis
• Hyperamylasemia
• Pancreatoduodenectomy
• Distal pancreatectomy