Clinical and radiologic features:
(1) The patient has a history of acute or chronic pancreatitis.
(2) The patient presents with gastric outlet obstruction (vomiting, abdominal discomfort, a distended stomach, etc).
(3) An obstruction involving the duodenum can be demonstrated on imaging studies and/or endoscopy.
(4) It may be accompanied by biliary obstruction.
(5) Other causes of gastrointestinal obstruction (stricture, torsion, etc) are ruled out.
It is important to consider other diagnoses that may have contributed to the pancreatitis:
(1) duodenal diverticulum
(2) surgical complication
(3) occult malignancy
Surgical management depends on the nature of the obstruction and the cause:
(1) gastrojejunostomy
(2) gastroduodenostomy
(3) duodenoplasty
(4) Whipple procedure (pancreatoduodenectomy)
Additional operative steps may include:
(1) vagotomy
(2) biliary diversion
