Jaundice may occur in up to one-third of patients with chronic calcific pancreatitis at some point during the disease, usually when there is pancreatic swelling at the time of an episode of acute pancreatitis. This often resolves as the acute inflammation subsides, but as many as 10% of patients are left with obstruction of the common duct. This is due to fibrosis of the head of the pancreas resulting in constriction of the duct as it passes through this portion of the gland. The stricture usually appears as a long, symmetrical narrowing when it is visualized by magnetic resonance cholangiopan-creatography or endoscopic retrograde cholangiography. The proximal duct and gallbladder may be distended, but obstruction of the duct is almost never complete, which differentiates it from a malignant obstruction. A simple biliary bypass using a Roux-en-Y choledochojejunostomy effectively treats such a biliary stricture. Endoscopic procedures are discussed in the next chapter.
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