Abdominal Pain Following Total Pancreatectomy With Islet Autotransplantation

Objective: Total pancreatectomy with islet autotransplantation (TPIAT) is increasingly used as an option for the treatment of chronic and recurrent acute pancreatitis in selected patients. Studies have shown significant improvements in pain, quality of life, and opioid use postoperatively. However, in long-term follow-up, over half of the patients have episodes of abdominal pain following TPIAT. The aim of this work is to describe the array of causes of abdominal pain in this complex and growing patient population. Methods: We conducted multidisciplinary discussions with experts at our institution and reviewed literature, where available, to identify and describe the diverse causes of abdominal pain following TPIAT. Results: We identify 15 distinct causes of abdominal pain following TPIAT, describing their presentation, workup, and management. Conclusion: As more patients undergo TPIAT, we must plan for and address the associated causes of abdominal pain that result from alterations in anatomy and physiology, both in the short and long term.