A Case of Recurrent Chronic Pancreatitis with an Incarcerated Pancreatic Stone after Pylorus-preserving Pancreatoduodenectomy

Abstract

A 66-year-old man was admitted to our hospital in August 2003 after an episode of postprandial abdominal pain. He had undergone pylorus-preserving pancreatoduodenectomy for chronic pancreatitis and pancreatic head pseudocyst in February 1993. Upon admission, his serum amylase and pancreatic amylase levels were elevated at 1169 IU/L and 1111 IU/L, respectively. Abdominal echo and computed tomography studies revealed pancreatic stones and dilatation of the main pancreatic duct. These findings led to a diagnosis of acute exacerbation of chronic pancreatitis. Although the patient improved with conservative medical treatment, surgical intervention was required to prevent future recurrence. Opening of the main pancreatic duct revealed an incarcerated pancreatic stone in the pancreatojejunostomy. After removal of the stone, side-to-side pancreaticojejunostomy and Roux-en-Y reconstruction were performed. The patient was discharged on postoperative day 15 and had no recurrent pain during the 4-month follow-up period. We conclude that even in cases in which pancreatoduodenectomy has been performed, chronic pancreatitis can persist despite conservative medical therapy, and surgery is indicated.