EFFECT OF BOUGINAGE AND WASHING OF THE PANCREATIC DUCT ON THE COURSE OF EXPERIMENTAL ACUTE PANCREATITIS
Authors: Kostyuk G.Ya. , Kostyuk O.G. , Burkov M.V. , Fomina L.V. , Golubovsky I.A. , Kostyuk V.G. 
Published: August 2018

The presence of many hypotheses of the development of acute pancreatitis such as pancreatic duct hypertension, pancreatic reflux, vascular, allergic, neuro-reflex, infectious, etc. confirm the lack of a clear understanding of the development mechanisms of this pathology, and hence inaccuracy in the treatment and negative consequences. The purpose of this study was to investigate the effect of bouginage and flushing of the pancreatic duct on the course of experimental acute pancreatitis. Experiments were carried out on 12 dogs, for which a model of pancreatitis was created by autobile administration into the pancreas duct. Animals were divided into four groups, 3 animals per each, with the term of deduce from the test in one, three, seven days and six months respectively. Before the pancreas duct perfusion, it was injected with polyvinylchloride bougie that was removed through the incision in the distal part of the pancreas duct. Such manipulation allowed to conduct duct washing with medicinal substances at a pressure of 0.49-0.6 kPa and confirmed the assumption that in acute pancreatitis, filling of pancreas duct with condensed protein masses was observed, and this, changes the approach not only to the establishment of the pathogenetic link in the process of acute pancreatitis development, but also to its treatment. The duct was washed once. The common comprehensive drug therapy was carried out in dogs within the next five, six days. At the end of the first day, out of the 12 dogs, nine stood independently, the rest - on the second day. On the third day, all animals drank water, responded to stimuli. On the fifth day they were active, taking liquid feed. On the seventh day on their behavior and feeding manner the dogs of this group did not differ from healthy ones. To study morphological changes in pancreas after duct washing, three dogs were withdrawn from the test in one day. At autopsy effusion in peritoneal cavity was not observed. The left lobe of pancreas was a little bit shorter. Place of dissection of the tissues of the pancreas and the duct is covered with a blood clot. In the area of duodenum dissection, isolated patches of steatoenecrosis retained. Microscopically, in the duct area dissection changes in pancreas tissues, in general, were the same as in duct dissection without perfusion. At the same time, the plethora for this term was great. Necrotic centers of parenchyma were isolated and with moderate neutrophilic infiltration. Distant from the dissection zone in pancreas tissues there were minor focal hemorrhages with a violation of its structure, however, hyperplasia, foci of neutrophilic infiltration of the interstitial connective tissue were less manifestated. In the proximal part of the duct, the pancreas tissue retained moderate plethora. In addition, there were small foci of hemorrhages with a violation of the structure of individual acinus and slight neutrophilic infiltration in interstitial connective tissue. The latter was also marked by the accumulation of macrophages and the proliferation of fibroblasts, there were isolated areas of hemorrhages. In intact part there was an insignificant edema of interstitial connective tissue. As a result of the conducted experiments, we were convinced of the effectiveness of this method of treating acute pancreatitis.