Chronic Pancreatitis

Chronic pancreatitis is a progressive inflammatory condition of the pancreas characterised by irreversible structural damage — fibrosis, acinar cell destruction, and ductal scarring — leading to permanent impairment of both exocrine (digestive enzyme) and endocrine (insulin) function. In India, chronic pancreatitis has a distinct profile: tropical pancreatitis (idiopathic, affecting young non-drinkers in southern and western India, often with large intraductal calculi) and alcoholic chronic pancreatitis are the two most prevalent forms. Other causes include hereditary pancreatitis (PRSS1, SPINK1 mutations), autoimmune pancreatitis, obstructive pancreatitis, and hypercalcaemia.

The hallmark of chronic pancreatitis is intractable abdominal pain, typically epigastric, radiating to the back, worsened by eating, and unrelieved by standard analgesics. As the disease progresses, patients develop exocrine insufficiency (steatorrhoea, weight loss, fat-soluble vitamin deficiencies) and endocrine insufficiency (pancreatogenic type 3c diabetes mellitus). Complications include pancreatic pseudocysts, ductal strictures, biliary obstruction from a strictured intrapancreatic bile duct, splenic vein thrombosis, and — in a small subset — progression to pancreatic carcinoma. Diagnosis is confirmed with CECT, MRCP, and endoscopic ultrasound.

Management begins with lifestyle modification (strict alcohol abstinence, low-fat diet), pancreatic enzyme replacement therapy (PERT), and analgesic management. Endoscopic therapy — ductal stenting, pancreatic stone extraction, extracorporeal shockwave lithotripsy (ESWL) — provides relief in selected patients. Surgery is indicated for failed medical/endoscopic therapy, large inflammatory masses, ductal obstruction, or complications. Surgical options include lateral pancreaticojejunostomy (Puestow-Partington procedure) for dilated ducts, Frey's procedure (duodenum-preserving pancreatic head resection with lateral pancreaticojejunostomy) for inflammatory head masses, and Beger's procedure for isolated head disease. Our surgeons offer the complete range of surgical solutions for complex chronic pancreatitis.