Angiographic Visualization of the Secretin-Stimulated Pancreas

Abstract

The visualization of the pancreas and its vasculature has to date given inconsistent and variable results. Conventional and specialized roentgen technics have failed to yield reproducible patterns in the normal and diseased pancreas. Such highly specialized procedures as subselective catheterization of the pancreatic arcade, utilizing the double catheter method, only occasionally result in adequate visualization (1, 2). Recently, Kisseler et al. (3) showed that when the pancreas is stimulated by administration of 1–2 units of secretin per kilogram of body weight, the organ will concentrate contrast medium sufficiently to allow visualization with conventional tomographic technics together with retroperitoneal air insufflation. The purpose of this communication is to describe our initial findings during angiography of the secretin-stimulated pancreas. To the best of our knowledge, no similar approach to this problem has appeared in the literature. Method Premedication consisted of intramuscular injection of 50 mg meperidine HCl and 50 mg promazine HCl. To more adequately visualize the retrogastric space, the stomach is outlined by a combination of endo-and perigastric gas according to the technic of Frimann-Dahl and others (4, 5). By means of a percutaneous transfemoral approach a catheter is passed selectively into the celiac and/or superior mesenteric arteries. One hundred fifty units of secretin is injected directly into the catheter. Immediately thereafter (two to three minutes) arteriography is performed, using 40 cc diatrizoate methylglucamine, an injection pressure of 75–100 lb./sq. in., and filming rates of 2 per second for four seconds and 1.5 per second thereafter for a total of 26 films. Results With this technic we have examined only 3 patients in whom disease was suspected. All were later proved normal. No untoward reactions were observed. Figures 1–4 show the excellent delineation of the pancreatic vasculature obtainable during arteriography when the examination is preceded by secretin administration. Discussion Our preliminary findings suggest that the rich vascular bed of the pancreas can be opacified by stimulating the organ with secretin. This ability of the pancreas to respond to hormonal stimulation has been previously well documented (3). Our small series has so far yielded consistent results. It is evident that this method must be applied to a larger group of patients before any definite conclusions can be drawn regarding the efficacy of arteriography in the secretin-stimulated pancreas. Summary Pancreatic arteriography combined with hormonal stimulation by secretin has yielded excellent opacification of the vascular bed of the pancreas. Preliminary investigation on a small group of patients leads the authors to believe that the method shows great promise and is worthy of further study.