I was told that I had stones in my pancreas. The surgeon split my pancreas and removed the stones. How do stones get into the pancreas, and what type of stones are they?

W.D.

Stones in the pancreas are usually the result of a condition known as chronic pancreatitis. This is a chronic inflammation of the pancreas that most often occurs in people who consume a lot of alcohol over a long period of time. Other causes of chronic pancreatitis include thyroid-related problems and autoimmune disease. Unlike the situation in acute pancreatitis, the damage to the pancreas in chronic pancreatitis is permanent and can result in multiple complications. These include diabetes (from a failure of the pancreas to produce insulin), diarrhea (because of impaired release of pancreatic digestive enzymes) and -- most commonly -- chronic, debilitating abdominal pain. The causes of pain include inflammation of nerves within the pancreas and obstruction of the pancreatic duct.

Obstruction of the pancreatic duct, with a corresponding increase in pressure in the gland, occurs because of scarring in the duct and/or stones that may form in it. Pancreatic stones occur when a combination of calcium and protein plugs the duct. Such stones can be removed from the pancreatic duct endoscopically (through a tube threaded down the throat and into the digestive tract), using small catheters to pull the stones out or to break them apart. This procedure should only be performed by gastroenterologists experienced in this advanced technique. Published studies show that significant reductions in pain can be achieved using this therapy.

As you described, surgery is another possible mode of therapy for stones that obstruct the pancreatic duct. Various surgeons use different approaches, all with the goal of decompressing the duct. Typically, the pancreatic duct is opened, the stones removed and the duct drained into the small bowel. Again, results with this technique are variable and depend to a great extent on the experience of the surgeon performing the procedure. Close follow-up with the surgeon and gastroenterologist is important to follow the course of chronic pancreatitis and possibly provide additional treatment if needed.