We appreciate McCutcheon's interest in our article on the phenomenon of acute pancreatitis after gastrectomy.1 We are aware of the older literature on the occasional causation of pancreatitis by the pathologic anatomy of a Polya anastomosis, which is liable to cause afferent loop obstruction by kinking or excessive bending. That mechanism is akin to, but different from, the specific strictures located at a point proximal to and separate from the anastomosis (Polya or Hofmeister) to which we called attention. We suggested that these very localized strictures may have been caused by injury from the application of bowel clamps to prevent spillage of intestinal contents during the gastrojejunal anastomoses.
We agree that the pathogenesis of pancreatitis in both instances is most likely due to a closed duodenal loop that promotes both pancreatic duct hypertension and reflux of duodenal contents, including enterokinase that is the natural activator of trypsinogen.
Warshaw AL, Mithöfer K. Acute Pancreatitis Complicating Polya Gastrectomy-Reply. Arch Surg. 1997;132(4):452. doi:10.1001/archsurg.1997.01430280126027
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