Chronic Relapsing Pancreatitis

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Chronic relapsing pancreatitis, as described by Comfort, Gambill, and Baggenstoss,1 is a distinct clinical entity representing a summation of repeated attacks of acute interstitial (edematous) pancreatitis, repeated sublethal attacks of acute necrotic pancreatitis, or a combination of the two types. Fibrosis or necrosis and atrophy are the constant chronic changes; pancreatic lithiasis, pseudocysts and cysts are less frequent evidence of chronic damage.

I. Etiology

From clinical survey, Morton2 summarizes the five principal contributing causes of pancreatitis as follows:

  1. Trauma, accidental or surgical.

  2. Infections, with extension to the pancreas or biliary tract.

  3. Toxic agents such as alcohol, drugs (arsphenamine), anesthetics.

  4. Biliary obstructions such as stones, spasm, infection, tumor, and duodenal diverticulum.

  5. Circulatory factors such as stasis, hypertensive apoplexy, thrombosis, and embolism.

Pediatricians find that pancreatitis may result from the presence of round worms in the pancreatic duct. They believe the most frequent cause to be hereditary syphilis. They also find that this disease accompanies gastroenteritis. Chronic pancreatitis is also seen in diabetes mellitus of childhood. Some cases of infantilism are believed to be associated with disturbances of the functions of the pancreas.3

Before recurrent pancreatic attacks were recognized as evidence of pancreatic degeneration, chronic disease of this gland was considered to be associated only with disorders of the parenchyma, as seen in carcinoma, inflammation caused by penetrating ulcers, pancreatic calculi, chronic disease of the liver or gallbladder, generalized arteriosclerosis, and benign or malignant occlusion of the pancreatic duct. Syphilis and alcoholism have been classed as primary. . .



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