Pancreaticoduodenal Resection in the Long-Term Period After Beger Procedure

Background We present a case report of chronic pancreatitis complicated by compression of the common bile duct, and segmental portal hypertension. Chronic pseudotumorous cephalic pancreatitis, postnecrotic cysts of this localization, persistent abdominal pain, biliary hypertension are the indications for surgical intervention. Two versions are discussed in the literature: 1 — organ-preserving operation with duodenum protection and natural bile flow preservation, and 2 — pancreaticoduodenal resection with biliodigestive drainage. Each method has advantages and disadvantages. The progression of chronic pancreatitis, duodenal dystrophy, and mechanical jaundice in the long-term period after the Beger procedure are indications for proximal pancreatic resection.

The aim was to present a case report of staged surgical treatment of cephalic chronic pancreatitis with biliary hypertension and pain syndrome.

Material and methods A 34-year-old male who abused alcohol, underwent the Beger procedure for post-necrotic cyst of the pancreatic head and biliary hypertension because of ineffective conservative treatment. The biliary drainage was removed 1,5 months later. In 3 days, acute pain appeared in the right hypochondrium. Biliary hypertension was diagnosed and treated with transpapillary stenting of the choledochus. Follow-up examination was scheduled in 3 months, but the patient did not come.

The male presented to our Clinic 8 years later with choledocholithiasis, jaundice, and duodenal passage disorder. Duodenal dystrophy was diagnosed, and pancreaticoduodenal resection was performed.

Results The Beger procedure and choledochus stenting ensured a satisfactory health level for several years. The patient did not follow a diet and systematically included alcohol in the menu. He didn’t show up for the checkup. Pancreatoduodenal resection effectively solved the problems that appeared.

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