A Case of Postoperative Congenital Duodenal Stenosis With Complex Pancreatic Duct Anomalies Treated With Open Pancreaticolithotomy

Abstract

The patient was a 6-year-old boy with a history of duodeno-duodenostomy on the third day after birth. He complained of persisting abdominal pain for three days and was referred to our hospital. His pancreatic enzyme levels were elevated, and abdominal ultrasonography revealed a pancreatolith with a dilated pancreatic duct. An enhanced CT scan revealed pancreatic enlargement and a pancreatolith, leading to a diagnosis of obstructive pancreatitis. MRI showed numerous pancreatoliths that filled the head of the pancreas, which are associated with complex anomalies of the pancreatic duct. Open pancreatolithotomy was performed since the endoscopic removal was unsuccessful. The dilated pancreatic duct was identified at the point between the head and body of the pancreas by ultrasonography, and the duct was incised, accomplishing the complete removal of the pancreatolith. Intraoperative pancreatography revealed that the pancreatic duct in the head was trifurcated with two out of three openings into the duodenum. Furthermore, dilation of the branches and collateral pathway formations were observed. There was no stenosis at the duodenal papilla. Transduodenal pancreatic duct tubes were placed through the major and minor papillae. His postoperative course was uneventful, and there was no recurrence of pancreatitis after 12 months of follow-up. Open pancreatolithotomy may well be an effective method for understanding the pancreatic duct anatomy and for removing pancreatic stones in patients with complicated pancreatic ductal malformations.