Pancreatic head resection alongside side-to-side pancreatic duct-jejunostomy for pancreatic stones: A case report and review of literature.

Abstract

Background: Pancreatic duct stones often develop in the late stage of chronic pancreatitis. However, for complex pancreatic duct stones or stones in the pancreatic body and tail, endoscopic treatment is often ineffective and ultimately requires surgical intervention.

Case summary: A young man who had been smoking for 10 years and drinking alcohol for 5 years had a history of abdominal pain for 8 years and diarrhea for 2 years. The patient was diagnosed with "chronic pancreatitis combined with pancreatic duct stones" in other hospitals and underwent several endoscopic treatments, but the abdominal pain still recurred. The patient presented to our hospital one week after another episode of abdominal pain. Our team arranged for computed tomography and magnetic resonance imaging examinations, which revealed a markedly atrophic pancreas and a dilated pancreatic duct, and a large number of stones. Our team convened a multidisciplinary consultation to discuss treatment options and reviewed extensive literature. Ultimately, based on the literature and consultation advice, we implemented a novel, previously unreported surgical procedure. The surgical approach we proposed combines the Beger procedure and the Frey procedure, involving complete pancreatic head resection with duodenal preservation, full-length longitudinal incision of the pancreatic duct in the body and tail, and side-to-side pancreaticojejunostomy. Postoperative follow-up revealed a favorable prognosis.

Conclusion: The main contribution of this case is the development of a modified surgical procedure for chronic pancreatitis complicated by complex pancreatic duct stones. For chronic pancreatitis complicated by stones that respond poorly to pharmacotherapy or endoscopic treatment, surgery is a worthy early treatment option. Early surgical intervention can effectively drain pancreatic juice, delay pancreatic atrophy, and protect pancreatic function. Our proposed modified procedure can more thoroughly remove stones and reduce the recurrence rate of stones and pain. Although we successfully treated a patient with this procedure for the first time, its efficacy and safety in a human population are currently lacking validation.