Abstract

Recent histopathology findings suggest that significant pancreatic parenchyma lesions leading to chronic pancreatitis may be due to pseudocyst development in the course of acute alcoholic pancreatitis. On the other hand, some authors consider alcohol induced 'acute' pancreatitis as symptoms of early, clinically latent chronic pancreatitis. The complications of acute pancreatitis remain controversial, which may result from an insufficient number of clinical investigations concerning late follow-up of both the structure and function of the pancreas in patients with pseudocysts. The choice of pancreatic pseudocyst treatment should consider optimal maintenance, during the long run of pancreatic function and structure . The purpose of this study is to evaluate the late outcome of pancreatic pseudocysts as a complication of acute alcoholic pancreatitis. 50 patients (16 women and 34 men), aged between 17-69 years (mean age 45.6±14.3) underwent clinical, functional and imaging tests two times: at the time of pseudocyst recognition and 2.5-5 years later (mean 3.8±1.7). Among these patients, 10 were treated expectantly, 18 surgically and in 22 an USG controlled percutaneous drainage was performed. During the first check-up, pain was observed in 44 (88%) patients, exocrine pancreatic function impairment- in 5 patients (10%), glucose tolerance impairment or diabetes-in 2 patients (4%) and no calcifications were seen on ultrasound or computed tomography. During the second check-up, abdominal pain persisted in 16 (32 %) patients, deterioration of pancreatic exocrine function was seen in 16 patients (32%), endocrine impairment in 13 (26%) patients and calcifications appeared in 18 (36%) patients as in comparison to the first examination. A worse outcome was seen more frequently in patients following severe acute pancreatitis, several attacks of the disease, those who continued to drink and those treated surgically.These findings support the concept of acute alcoholic pancreatitis attacks leading to chronic pancreatitis.This may have a prognostic significance as well as provide additional criteria in the management of patients with pancreatic pseudocysts.

Keywords: acute pancreatitis, pancreatic pseudocyst, pancreatic function, pancreatic structure, pancreatitis management