Effects of Acute Pancreatic Duct Obstruction on Pancreatic Perfusion: Implication of Acute Pancreatic Duct Decompression

Abstract

Background: Acute pancreatitis can result in pancreatic ischaemia and necrosis. Pancreatic duct (PD) obstruction may be the first step causing ischaemia in acute pancreatitis. Nitric oxide donors can attenuate acute pancreatitis through improvement in compromised pancreatic perfusion (PP). In this study, we determined if (1) PD obstruction altered PP and (2) PD decompression or L-arginine administration reversed this change. Methods: Fifteen Australian possums were randomly assigned to two groups: Animals in group A ( n = 6) were subjected to 30 min of PD obstruction and 60 min of PD decompression. Animals in group B ( n = 9) were subjected to 120 min PD ligation and 60 min PD decompression. A subset group B ( n = 6) were subjected to intravenous L-arginine (100 μg/kg) at the end of 120 min of ligation and at the end of PD decompression. The PP (Laser Doppler fluxmetry), PD pressure and blood pressure were continuously monitored. Results: PD pressure increased from 2.9 ± 2.5 to 18.1 ± 4.9 mmHg following PD ligation. PP was reduced to 67.1% ± 4.5% ( P < 0.01) and 46.2% ± 7.5% ( P < 0.001) of baseline following 30 and 120 min of PD ligation, respectively. Following 60 min of PD decompression, PP was restored to 89.1% ± 13.4% ( P < 0.02) of the baseline in the 30-min group. However, following 120 min PD ligation, PP remained depressed. L-arginine administration after 120 min of PD ligation transiently increased PP from 46.2% ± 7.5% to 81.1% ± 8.6% ( P < 0.03) of baseline. This effect was reproduced if L-arginine was administered at the end of decompression ( P < 0.05). Conclusion: In patients with acute pancreatitis due to obstructive causes, early decompression of the PD may prevent early pancreatic ischaemia.