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Ground-breaking surgery provides relief for debilitating pancreatitis

We are IU Health

June 30, 2020

In what is a first for IU Health, and for Indiana, a team of specialists recently completed an intricate procedure on a young mother plagued with painful pancreatitis.

By IU Health Senior Journalist T.J. Banes, tfender1@iuhealth.org

The pain is excruciating. In the most severe cases, the symptoms can become debilitating.

Pancreatitis, an inflammation of the pancreas has a number of causes including infections, excessive alcohol intake, autoimmune diseases, trauma and surgery. Some medications may result in pancreatitis. It is also aligned with a family history. But in a number of patients, there is no known cause.

What physicians and patients do know is that acute pancreatitis causes severe abdominal pain and over time can cause damage to tissues, and organs such as the heart, kidney, and lungs. The abdominal pain can come on suddenly and can be accompanied by fever, nausea and diarrhea.

The National Pancreas Foundation reports nearly 220,000 Americans suffer annually with acute pancreatitis, and more than 80,000 people are diagnosed with chronic pancreatitis.

Patients are often hospitalized, their symptoms treated and they wait until the next onset. Many patients have said they are unable to maintain typical lives – parenting, working and living independently.

Last week, new hope came to light when a team of caregivers with IU Health completed the hospital’s first total pancreatectomy with islet cell autotransplantation (TPIAT). The female patient in her early 20s is a young mother who suffers from hereditary pancreatitis. Her recovery is ongoing for several weeks.

The procedure is a two-step process involving a number of IU Health practitioners including gastroenterologists, pain medicine specialists, nutritionists, a gastrointestinal psychologist, endocrinologists, intervention radiologists, a pancreatic surgery team, and a pancreatic nurse coordinator. In the first multi-hour surgery, the patient’s pancreas was removed and the gastrointestinal tract was reconstructed. Among the OR team members were nurse Jenna Elliott, surgical technician Molly Pentecost; scrub assistant Danica Caylor, Dr. Nicholas Zyromski, surgeon, and Dr. Mohammed Al-Temimi, assistant surgeon.

In the second phase, an off-site partner company specializing in cell therapies for patients with pancreatic disease removed islet cells from the pancreas. The cells produce insulin that helps regulate blood sugar levels. The cells were then reintroduced into the patient’s liver to begin producing insulin. Essentially, the process is similar to organ transplantation, in this case using the patient’s own tissue.

“Patients can live without a pancreas, but it’s difficult to manage diabetes. By reinserting some of the cells, we are able to help the patient with the pain management and better control of blood sugar fluctuations associated with diabetes,” said surgeon Dr. Nicholas Zyromski, who has been with IU Health for 16 years. “We are excited to be the first program in Indiana to provide TPIAT. This is an important treatment option for select patients with chronic and recurrent acute pancreatitis. This new program aligns with IU Health's goal to provide patients with leading-edge treatment options and access to medical and surgical specialists that are not available elsewhere in Indiana," said Zyromski. IU Health team members hope to offer the procedure to about a dozen patients a year.

Zyromski added that the patients ideally suited for the procedure are generally those with hereditary chronic pancreatitis and generally in their 20s and 30s. Patients of other ages can also be considered for the procedure. Patients who are interested in learning more about the procedure or other ways to manage symptoms of pancreatitis can reach out to IU Health nurse Kathy McGreevy, a patient navigator at kmcgreev@iuhealth.org or (317) 948-2616.

“This is a major accomplishment that brought together various disciplines,” said Zyromski. “It shows that there is a way to help patients long-term with these debilitating symptoms of this devastating disease.”

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