Open Internal Stenting of the Main Pancreatic Duct as Life-Saving Surgery in a Critically Ill Patient with Chronic Frequently Relapsing Pancreatitis and Pancreatic Ductal Hypertension

Patient: Male, 63 Final Diagnosis: Chronic frequently relapsing alcoholic pancreatitis (relapsing phase) • pancreatic ductal hypertension • parapancreatic inflammatory mass • fermentative ascites-peritonitis • two-sided pleural effusions • sepsis • cachexia Symptoms: Upper abdominal pain • fatigue • an increase in volume of the abdomen • loss of appetite • weight loss Medication: — Clinical Procedure: Open internal stenting of the pancreatic duct Specialty: Surgery OBJECTIVE: Management of emergency care BACKGROUND: The effective and safe treatment of chronic frequently relapsing pancreatitis is challenging. CASE REPORT: We present the case of a 63-year-old male patient with severe complications of this variant of the disease: parapancreatitis with the formation of an inflammatory mass, fermentative ascites-peritonitis, 2-sided pleural effusions, sepsis, and cachexia. Conservative treatment was ineffective, and emergency surgery was chosen. A novel surgical procedure – open internal stenting of the main pancreatic duct via pancreatowirsungotomy and duodenotomy – was used successfully in this difficult case. The elimination of pancreatic ductal hypertension and maintenance of maximum physiological pancreatic juice outflow, achieved via surgery, led to rapid improvement in the patient’s condition. He was discharged on the 26(th) day after surgery. The clinical outcome was good at the 2-year follow-up. CONCLUSIONS: Open stenting of the main pancreatic duct can be recommended for treating patients similar to the patient described in this paper – having severe complications of CP against the background of a relapse, exhaustion, and being in a severely or critically ill general condition. This surgical procedure is especially important when minimally invasive methods of eliminating pancreatic hypertension are technically unsuccessful or impossible due to the lack of necessary equipment and staff.