Pancreatitis

Pancreatitis is an inflammation or swelling of the pancreas that can be caused by gallstones, alcohol abuse, certain medication or drugs, or even trauma. The inflammation may be sudden (acute) or ongoing (chronic). Acute pancreatitis usually involves a single "attack," after which the pancreas returns to normal. In chronic pancreatitis, permanent damage occurs to the pancreas, often leading to destruction of pancreatic tissue and increasing the risk of diabetes, pancreatic cysts and pancreatic cancer. Learn more about pancreatitis.

Most people with pancreatitis will not require surgery, but if they do, it is used to relieve symptoms and complications. These include infection, bleeding, blockage of pancreatic ducts, leakage of pancreatic fluid (sometimes called a fistula) or chronic pain. Brigham and Women's Hospital (BWH) is one of the few medical centers in the Northeast with in-depth experience in pancreatitis surgery. Our board certified general and gastrointestinal surgeons offer traditional surgical options and the latest minimally invasive surgery techniques for pancreatitis, including islet cell transplantation and total pancreatectomy, the Whipple procedure (pancreatoduodenectomy) and endoscopic and laparoscopic pancreatic cyst drainage.

Diagnosis of Pancreatitis

General and gastrointestinal surgeons at BWH offer a range of procedures for diagnosing pancreatitis:

Computed tomography scan (CT or CAT scan)
Magnetic resonance cholangiopancreatography (MRCP)
Endoscopic retrograde cholangiopancreatography (ERCP)
Endoscopic ultrasound

Learn about diagnostic tests for pancreatitis.

Treatment for Pancreatitis

Non-Surgical Treatment for Pancreatitis

Pancreatitis can often be treated with a few days in the hospital where you will receive intravenous fluids, medicines to relieve pain, and nutritional support. Non-surgical treatment options include:

Intravenous (IV) fluids
Antibiotics
Pain control
Nutritional support
Avoiding alcohol
Low fat, nutritious diet
Enzyme supplements
Medicine to reduce gastric acid

Surgical Treatment for Acute Pancreatitis

When non-surgical treatment methods are not working and pancreatitis complications continue, BWH general and gastrointestinal surgeons offer extensive expertise in:

Endoscopic retrograde cholangiopancreatography (ERCP) to remove gallstones or open any collapsed ducts with or without sphincterotomy and stent placement. This is performed by BWH gastroenterologists.
Laparoscopic, robotic, and open cholecystectomy to remove the gallbladder and prevent further gallstone related pancreatitis.
Surgical necrosectomy and pancreatic debridement to remove dying or dead (necrotic) pancreatic tissue.
Image guided percutaneous catheter drainage to drain fluid from the pancreas.
Endoscopic necrosectomy to access necrotic pancreatic tissue without incisions and internally drain into the stomach.

Surgical Treatment for Chronic Pancreatitis

Our general and gastrointestinal surgeons offer the most advanced surgical approaches for patients with severe chronic pancreatitis:

ERCP and EUS (endoscopic ultrasound) to remove gallstones, open any blocked ducts, and diagnose and drain fluid collections.
Necrosectomy to remove dying or dead (necrotic) pancreatic tissue. This can often be performed endoscopically, without incisions, using ultrasound guidance to debride the pancreas through the stomach.
Laparoscopic, robotic and open cholecystectomy
Pancreatic cyst drainage Chronic collections of pancreatic fluid or necrosis are connected to the stomach (cystogastrostomy) or small intestine (cystojejunostomy) to allow internal drainage of the cyst contents. This can be done endoscopically, laparoscopically or by traditional open surgical techniques.
Pancreatectomy is the surgical removal of all or part of the pancreas.
- Pancreaticoduodenectomy is a procedure in which the head of the pancreas, the gallbladder, nearby lymph nodes and part of the stomach, small intestine, and bile duct are surgically removed. Also called the Whipple procedure.
- Distal pancreatectomy is surgery to remove the body and tail of the pancreas. The spleen may also be removed.
- Segmental pancreatectomy
- Total pancreatectomy is the removal of the entire pancreas
Lateral pancreaticojejunostomy (LPJ), also known as the Puestow procedure, is a complex procedure performed for chronic pancreatitis when the pancreatic duct is dilated and unable to drain properly.
Total pancreatectomy with islet auto-transplantation (TP-IAT) In severe cases, the pancreas needs to be removed to treat unrelenting pancreatitis. BWH is one of the few centers performing islet auto-transplantation. Insulin-producing islet cells are harvested from your own pancreas and transplanted into the liver at the time of pancreas removal, helping to prevent the development of diabetes.

What You Should Expect

You will receive a thorough diagnostic examination to evaluate if you have pancreatitis and determine and what course of treatment is needed. Careful monitoring and the involvement of an experienced general and gastrointestinal surgeon are important to the successful outcome for patients with pancreas conditions.

If you are having surgery or a procedure, you will likely be scheduled for a visit to the Weiner Center for Preoperative Evaluation for pre-operative information and tests.

The day of surgery, you will be taken care of in the operating room by surgeons, anesthesiologists and nurses who specialize in surgery for patients with pancreatitis. After surgery, you will go to the post-surgical care unit where you will receive comprehensive care by an experienced surgical and nursing staff.

Learn more about your hospital stay and returning home.

Multidisciplinary Care

Brigham and Women’s Hospital provides a multidisciplinary approach to patient care, collaborating with colleagues who have extensive experience in diagnosing and treating pancreatitis. In addition, patients have full access to BWH’s world-renowned academic medical community with its diverse specialists and state-of-the-art facilities.

General and Gastrointestinal Surgery Appointments and Locations

Resources

Go to our health library to learn more about pancreatitis.

Visit the Kessler Health Education Library in the Bretholtz Center for Patients and Families to access computers and knowledgeable staff.

Visit the Weiner Center for Preoperative Evaluation.