A rare case of duodenal obstruction due to chronic pancreati
This article is published in the journal MEDICINE.

Duodenal obstruction (DO) accompanied by chronic pancreatitis is very rare, with a reported occurrence in <1% of patients with chronic pancreatitis.

A 68-year-old man presented with chief complaints of nausea and abdominal pain. He had a significant past medical history of chronic pancreatitis with pseudocysts, which had been treated using endoscopic ultrasonography-guided transgastric cyst drainage with a covered metal stent a year ago. On abdominal examination, epigastric fullness was observed and a succession splash was heard. Computed tomography (CT) revealed gastroduodenal expansion with an obstruction at the horizontal portion of the duodenum, a shrunken pseudocyst, and a pancreatic stone.

The primary approach was conservative therapy which failed. The patient was then operated. Roux-en-Y duodenojejunostomy and spleen-preserving distal pancreatectomy achieved through splenic vessel resection, known as “Warshaw operation” were performed. The intraoperative and histopathological findings indicated that prolonged inflammation produced scarring and constriction of the mesentery, resulting in stricture of the horizontal portion of the duodenum. The definitive diagnosis was DO due to chronic pancreatitis in the pancreatic tail (CPPT). The patient was uneventfully discharged after postoperative day 14. At his 9-month follow-up visit, he was doing well without any symptoms.

This is the first reported case of duodenojejunostomy combined with the Warshaw operation for DO due to CPPT.

Read more: https://journals.lww.com/md-journal/Pages/articleviewer.aspx?year=2019&issue=07050&article=00003&type=Fulltext