Ann Hepatobiliary Pancreat Surg.  2017 May;21(2):101-105. 10.14701/ahbps.2017.21.2.101.

Surgery for intractable pain in a patient with chronic pancreatitis complicated with biliary obstruction, portal vein stenosis and mesenteric venous collaterals

• Kayaalp C
• Dogan MS
• Ersan V

• KMID: 2379110
• DOI: http://doi.org/10.14701/ahbps.2017.21.2.101

Abstract

Pancreatic head resection for chronic pancreatitis is a challenging procedure, in the presence of venous collaterals, cavernous transformation, extensive fibrosis or porto-mesenteric stenosis or thrombosis. We present a surgically treated patient for the intractable pain of chronic pancreatitis. Complications with biliary obstruction and portal vein stenosis/thrombosis resulted in cavernous transformation. A pancreaticoduodenectomy combined with portal vein resection was intended in a 51 year-old male, but the procedure was terminated due to the high risk associated with intraoperative bleeding. The surgical procedure was switched to a Frey procedure, wherein partial pancreatic head resection, drainage of the pancreatic canal and sufficient pain palliation, without an increased risk of intraoperative hemorrhage, was ensured. The procedure was successfully combined with bilio-enteric anastomosis.

Keyword

Frey procedure; Chronic pancreatitis; Palliative care; Pain; Obstructive jaundice; Cancer

MeSH Terms

Constriction, Pathologic*
Drainage
Fibrosis
Head
Hemorrhage
Humans
Jaundice, Obstructive
Male
Pain, Intractable*
Palliative Care
Pancreaticoduodenectomy
Pancreatitis, Chronic*
Portal Vein*
Thrombosis

Figure

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  Fig. 1 Computed tomography image showing porto-mesenteric venous stenosis and metallic stent for biliary obstruction.

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  Fig. 2 Computed tomography image showing venous collaterals around pancreatic head.

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  Fig. 3 Illustration of cavernous transformation of porto-mesenteric veins.

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  Fig. 4 Operative photograph showing excavation of pancreatic head.

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  Fig. 5 Illustration of evacuated pancreatic head and the body.

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  Fig. 6 Operative photograph showing pancreatectomy extended to the body of the pancreas.

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  Fig. 7 Illustration of pancreatico-jejunostomy combined with bilio-enteric anastomosis.

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  Fig. 8 Correlation of abdominal drainage amount and the onset of diarrhea (arrow).

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