Question
A patient of chronic pancreatitis presented to casualty with upper abdominal pain. Pancreatic duct is 10 mm in size with calculi inside the duct. What is the best treatment plan for this patient?
| A. |
Gastrojejunostomy
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| B. |
Distal pancreatectomy
|
| C. |
Longitudinal pancreaticojejunostomy
|
| D. |
Total pancreatectomy
|
Show Answer
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Correct Answer � C
Explanation
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|
The scenario described is that of a patient with chronic pancreatitis who presents with ductal dilatation (greater than 7mm suggests significant ductal dilatation) and stones inside the duct. Among the choices given, the most appropriate treatment for such a patient with a large pancreatic duct and calculi would be a drainage procedure, and the procedure of choice for this is a longitudinal pancreaticojejunostomy, also known as the Puestow procedure or lateral pancreaticojejunostomy.
Longitudinal pancreaticojejunostomy (Puestow procedure): This is a decompressive procedure where the dilated pancreatic duct is opened longitudinally and joined to a loop of the jejunum. This allows for the removal of ductal stones and drainage of the pancreatic secretions into the jejunum. It’s particularly suitable for patients with a dilated duct and stones.
Other options:
– Option A: Gastrojejunostomy → gastric outlet obstruction, not ductal stones.
– Option B: Distal pancreatectomy → for disease in pancreas tail only.
– Option C: Longitudinal pancreaticojejunostomy → dilated duct, stones removal.
– Option D: Total pancreatectomy → entire pancreas removed, not first-line.
