One hundred years ago E. L. Opie proposed two distinct hypotheses to address the pathogenesis
of gallstone-induced pancreatitis. These hypotheses appear mutually exclusive. The
first predicts that impediment to the flow of pancreatic juice causes pancreatitis
(the pancreatic duct obstruction hypothesis), whereas the second predicts that bile
flow into the pancreatic duct behind an impacted gallstone would trigger the onset
of acute pancreatitis (the common-channel hypothesis). One of the more convincing
arguments against the latter hypothesis is the observation that bile, when experimentally
perfused through the pancreatic duct of dogs, does not induce pancreatitis. This experimental
situation had spontaneously developed in the patient we describe here: a biliopancreatic
fistula had permitted the continuous flow of bile through a large portion of the pancreas,
which was associated with cholangitis but had apparently never led to pancreatitis.
This patient’s case would suggest that in humans, just as in experimental animals,
bile flow through the pancreatic duct is not necessarily involved in the onset of
gallstone-induced pancreatitis and lends further support to Opie’s pancreatic duct
obstruction hypothesis.
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T. Pohle, M.D.
Department of Medicine B · University of Münster
Albert-Schweitzer-Strasse 33 · 48129 Münster · Germany
Fax: +49-251-8347570
Email: pohlet@uni-muenster.de
