Die Duodenalstenose bei chronisch-rezidivierender Pankreatitis

Duodenal wall cysts may be derived from a ductal component of ectopic pancreatic tissue

AIMS

To clarify the mechanism of origin of duodenal wall cysts in patients with chronic pancreatitis, developing into duodenal stenosis.

METHODS AND RESULTS

Specimens from 12 pancreatoduodenectomized patients with chronic pancreatitis and 51 controls were studied histopathologically and immunohistochemically. Variously shaped cystic lesions, averaging about 15 mm in diameter, were found in the duodenum in six of the 12 patients with chronic pancreatitis, but were not observed in the controls. Each case had an average of two cysts, which were located mainly in the muscularis propria of the duodenum with or without submucosal or extraduodenal-peripancreatic extensions. The inner part of the cyst wall consisted of a moderate rim of granulation tissue, with both myofibroblasts and smooth muscle proliferation in the tissue surrounding the cyst and the submucosal layer of the duodenum, occasionally accompanied by an epithelial lining. A ductal structure in the muscularis propria of the duodenum, possibly a ductal component of ectopic pancreatic tissue, was found in five of the six cases. Some of these structures showed cystic changes. Three of the six patients had accompanying duodenal stenosis.

CONCLUSIONS

Duodenal wall cysts occur mainly in the muscularis propria of the duodenum associated with both myofibroblasts and smooth muscle proliferation, and may result in duodenal stenosis. These cysts may be derived from a ductal component of ectopic pancreatic tissue.

Duodenal stenosis in chronic pancreatitis: clinicopathological correlations

Persistent duodenal stenosis has been noted as a complication of chronic pancreatitis, but its clinical importance and histologic basis have not been defined. We report three patients with chronic alcoholic pancreatitis who developed duodenal stenosis and intractable abdominal pain. In two patients, the stenosis was caused by severe inflammation of pancreatic tissue within the wall of the duodenum. Pancreaticoduodenectomy resulted in prompt and sustained clinical improvement in both patients. In the third patient, who had mural inflammation in the distal stomach and presumably in the duodenum as well, vagotomy and gastrojejunostomy relieved severe duodenal obstruction but not pain. This study supports the view that duodenal stenosis is caused by severe intramural duodenal inflammation and suggests that a pancreaticoduodenectomy may be required for relief of pain.