Abstract
A 66-year-old man, who had undergone pancreatoduodenectomy for a cancer of the duodenal papilla, was admitted to our hospital because of pancreatitis, 58 months postoperatively. Radiological examination showed the dilated remnant pancreatic duct with a protein plug. Although conservative therapy using a protease inhibitor was symptomatically effective, pancreatitis attacks reccurred frequently. Endoscopic balloon dilation for the pancreato-jejunal anastomosis resulted in remission of the attacks, but pancreatitis relapsed 6 months after the procedure with a protein plug and dilation of the pancreatic duct. Bromhexine hydrochloride was orally administered anticipating increasing in the secretion of pancreatic juice of low viscosity. Three months after starting this medicine, the protein plug in the pancreatic duct disappeared and the diameter of the duct decreased. In the 42 months since then, no pancreatic attacks nor protein plugs have occurred. Bromhexine hydrochloride therapy is a possible alternative for to treat residual pancreatitis after pancreatoduodenectomy, before attempting surgical or endoscopic therapy, which are invasive and complicated.
