My pancreas is digesting itself, what can doctors do?

Anoushka Sharp

The prequal to this article, why am I terrified of my pancreas?ended on a cliff hanger, after explaining the following points:

The pancreas makes digestive enzymes which break carbohydrates, proteins and fats into smaller molecules. When the pancreas gets injured, these digestive enzymes spill out, and break down nearby tissue. This creates necrosis (black gunky yuck as a result of unintentional cell death).

It’s actually quite hard to know if your pancreas is digesting itself, because it just feels like very intense tummy pain. Doctors call tummy-pain a ‘non-specific symptom’ – i.e. something whose cause could be many different things. However, doctors can identify pancreas injury by performing blood tests and medical imaging using ultrasound or X-rays. If blood tests show high levels of pancreatic digestive enzymes that should NOT be in the blood (they should only be in the pancreas), and medical imaging shows that the pancreas is a strange shape, then pancreas injury is diagnosed.

“Excuse me, my pancreas is digesting itself, PLEASE CAN YOU HELP?”

Yes. Sorry. OK. You will need surgery to remove the necrosis. The procedure is called a pancreatic necrosectomy and there are five stages:

  1. Make holes or cuts so that surgical tools can reach the pancreas.
  2. Then, use a surgical hosepipe-hoover to suck up any pus (infected liquid), squirt antibacterial salt-water into the area, let it slosh around and finally hoover it up along with any other floaty bits of debris.
  3. Next, use a pair of tweezers to pull dead pancreas tissue out of the body.
  4. Then, use the surgical hosepipe-hoover again for a final clean.
  5. Now, sew up any holes or cuts using a needle and thread.

Surgical thread is called a suture, the hosepipe-hoover is called a suction-irrigation system and the surgical knife is called a scalpel.

How do surgical tools reach the pancreas in stage 1?

It’s not easy: the pancreas is buried deep in the middle of the abdomen, underneath the liver, above the intestines, behind the stomach, in front of the kidneys. Three possible routes are explained below.

Open surgery: slice and dig

Cut a big horizontal dome-shaped slice on the front of the tummy, just above the belly button. Then use a mixture of sharp scissors, blunt scissors, tweezers, and fingers to cut a path towards the pancreas via the underside of the stomach.

Laparoscopic surgery: poles through holes

Poke three holes in the skin just underneath the ribcage. Long, thin, bendy poles with surgical tools on the end are stuck through the holes in order to carry out the operation. One hole gets a pole with a camera on the end. The image from the camera is displayed on a big screen so the surgeons can see what they are doing. The second hole gets a long, thin balloon pump which inflates the area around the pancreas with carbon dioxide, blowing it up like a balloon so that other laparoscopic tools have room to move around. The balloon pump can also do the job of the surgical hosepipe-hoover (from stages 2 and 4). The final pole has a grabber on the end of it, which grabs handfuls of dead, digested pancreas tissue to pull out of the body.

Endoscopic surgery: less cuts more guts

Endoscopy involves sticking bendy poles with surgical tools on the end down passageways that already exist in the body, such as the digestive tract or urinary tract. Endoscopic pancreatic necrosectomy starts by inserting a long, thin hollow tube through the mouth, down the oesophagus, and into the stomach. The hollow tube has a camera on the end, whose image is shown on a big screen, similar to the laparoscopy operation. Other surgical tools on the end of long bendy poles take turns to be threaded down the hollow tube throughout the operation. The first tool is a thin needle which pokes a hole through the back wall of the stomach, straight into the pancreas. Next comes a deflated balloon, which is stuck down this newly created hole and inflated, to enlarge the hole. Now, the hollow tube can be pushed into the pancreas from the stomach, where it can act as a hosepipe-hoover. Next, a grabber tool is inserted down the hollow tube to remove the dead pancreas tissue, dragging it back through the hollow tube and out of the mouth.

This image shows the types of pancreatic necrosectomy surgery.

…and it’s now the end of the article…

Thank you for reading. I hope that you enjoyed learning how to remove damaged, self-digesting pancreases from those in need.