The role of ductal obstruction on the course of hemorrhagic pancreatitis in the pig.

The effect of relieving pancreatic duct obstruction after the onset of hemorrhagic pancreatitis was investigated. Hemorrhagic pancreatitis was produced in 20 pigs by a bile salt-trypsin retrograde injection technique. In half the pigs the pancreatic duct was permanently ligated, and in the other half the ductal obstruction was relieved 2 h after the onset of hemorrhagic pancreatitis. The overall mortality rate was the same in both groups by 24 h. No difference was found between the groups in the gross and microscopic appearance of histological samples taken from the pancreas immediately after death. The biochemical parameters measured to assess the severity of pancreatitis such as calcium, BUN, creatinine, glucose, proteins, and hematocrit did not show any difference between the two groups. The serum amylase level, a measure of ductal obstruction, was less at 24 h and even lower at 48 h in the release group as compared to the non-release group. This difference suggests that the ductal obstruction was relieved, as the amylase levels declined at 24 and 48 h. Hemodynamic variables, including cardiac output, pulmonary artery pressure, pulmonary wedge pressure, central venous pressure, and aortic pressure were followed. No significant difference was found in any of these parameters between the two groups. The absence of any significant differences in hemodynamic status, histopathological findings, and biochemical analysis in our pigs, if translatable to man, does not lend support to early operative intervention in gallstone pancreatitis in the hope that those patients who already have hemorrhagic pancreatitis will benefit from early pancreatic ductal decompression.