Laparoscopic Lateral Pancreaticojejunostomy for Chronic Calcific Pancreatitis with Impacted Pancreatic Duct Stent for More Than a Decade: Double Trouble

Aim: To assess the feasibility and safety of Laparoscopic Lateral Pancreaticojejunostomy in a patient with impacted pancreatic duct stent which was retained for more than a decade.

Presentation of Case: 62 year old male, known case of idiopathic chronic calcific pancreatitis with history of undergoing Endoscopic pancreatic duct stenting 12 years back presented with pain abdomen, steatorrhea, low grade fever and weight loss . A Contrast Enhanced Computerised Tomography scan done showed atrophic pancreas, dilated pancreatic duct, multiple stones along the pancreatic duct. An attempt to retrieve the stent by endoscopic approach was failed. In view of severe pain requiring escalating doses of analgesics and features of chronic pancreatitis he underwent totally laparoscopic lateral pancreaticojejunostomy with the retrieval of pancreatic duct stent. He was discharged on the 4th postoperative day . At 1 year follow up the patient is pain free and has also gained 9 kgs.

Discussion: Endoscopic pancreatic duct stenting provides relief from pain in severe chronic pancreatitis with ductal strictures and proximal dilatation. The stent needs to be exchanged frequently or on demand basis. Our patient underwent stent exchange twice and had lost for follow up for more than a decade. After extensive literature search ,we believe this is the first case report of totally laparoscopic lateral pancreaticojejunostomy performed in a patient with impacted and retained stent for more than a decade.

Conclusion: Laparoscopic lateral pancreaticojejunostomy for chronic calcific pancreatitis with retained ,impacted and infected previously placed endoscopic pancreatic duct stent is challenging, but safe and feasible in experienced hands.