The pancreatic duct is the tube in the pancreas which carries the pancreatic juice and enzymes from the pancreas to the small intestine (in the duodenum). Pancreatic enzymes are useful in digestion of food. Before its entry into the second part of the duodenum, the pancreatic duct joins with the common bile duct at the point called ampulla of vater, after which they enter the duodenum.
The pancreatic duct just like the pancreas is very important, and it cannot be ignored at any stage. Any problem within the duct can cause acute pancreatitis, a dreaded condition with high rate of mortality.Problems in the pancreatic duct can be due to compression, obstruction or enlargement (inflammation) of duct. Most common cause for enlargement of pancreatic duct is presence of gall stone in common bile duct.
Causes Of Enlarged Pancreatic Duct
The pancreatic duct extends transversely from left to right in the pancreas. It commences from the tail of the pancreas runs all through the body and head of pancreas before entering into the duodenum. Before entering in the small intestine it comes in contact with the common bile duct. The size of pancreatic duct near the duodenum is approximately that of an ordinary quill.
- Gall stone: The most common cause for enlarged pancreatic duct is an obstruction in the duct caused due to a stone, especially the gall stone. The tiny gall stone gets lodged into the ampulla of vater, and blocks the flow of pancreatic juice and bile into the duodenum. Due to the block, the bile may leak in the pancreas leading to its inflammation known as pancreatitis.
- Carcinoma: Another cause for enlargement is pancreatic duct carcinoma. It is one of the most common pancreatic cancer forms.
- Obstruction of ampulla of vater: by intestinal worm ascaris lumbricoid can occur sometime. It is very rare but the cause cannot be ruled out.
- Alcoholism: can disrupt the pancreatic duct and enlarge them and eventually cause pancreatitis.
Symptoms Of Dilated Pancreatic Duct
The symptoms of enlargement are that of pancreatitis either acute or chronic.
- Pain in the upper middle portion of abdomen often precipitated after a large meal.
- Pain can also precipitate after a bout of alcoholic drink.
- The pain is severe and persistent and radiates to the back.
- Pain is worse on lying down, but there is partial relief by sitting or stooping forward.
- Pain is often associated with vomiting and nausea.
- Distension of abdomen.
- Excessive perspiration.
- Moderate fever.
- Rapid pulse.
- Low blood pressure.
- Bluish discoloration around the umbilicus or in the flanks indicates severe form of disease.
- A mass may be felt in the upper abdomen representing a pseudocyst.
Enlarged Pancreatic Duct Treatment
Enlargement of the duct can be due to many causes. From the clinical examination if the doctor suspects pancreatitis as a cause. He may advice further tests to detect and confirm his diagnosis. It will also help to start necessary treatment.
Ultrasonogram, MRI and CT scanning are useful in detecting pancreatitis. They can also detect pancreatic stones.
Patient needs hospitalization and nothing is given by mouth in acute stage. Intravenous fluids are administered and a close watch on pulse and blood pressure is kept.
Treatment to widen the duct: in chronic pancreatitis there is pain due to narrowing of the duct and ampula of vater. This narrowing can block the secretion of the pancreas and inflame the duct as well as the pancreas. One way to widen the duct and the ampulla of vater is introducing a stent (tube) in the duct. The stent can reduce the pain and increase the flow reduced due to obstruction of the pancreatic stone. Inserting a stent in the duct has its limitation due to high risk in the procedure.
Pancreatic lithotripsy is another option to break the lodged stone in the enlarged pancreatic duct.
In most severe cases surgery may be the last option.