The pathogenesis of acute biliary pancreatitis: a controversial issue. Part II: The concepts of duodenopancreatic reflux and of obstruction of pancreatic exocrine secretion.

Acute pancreatitis associated with the passage of gallstones through the sphincter of Oddi might be caused by obstruction of pancreatic exocrine secretion or by duodenopancreatic reflux. Possible complicating factors are discussed, which are necessary in order to turn the interstitial edematous inflammation caused by pancreatic duct obstruction into hemorrhagic necrotizing pancreatitis. Furthermore, clinical and experimental data are reviewed concerning a possible collapse of the protective mechanisms which usually prevent contact of duodenal contents and pancreatic tissue.