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Modified Puestow Procedure for Chronic Pancreatitis in a Child Due to Annular Pancreas and Duodenal Duplication: A Case Report

Alatas Fatima Safira, Masumoto Kouji, Matsuura Toshiharu, Pudjiadi Antonius Hocky, Taguchi Tomoaki,
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 ( Alatas Fatima Safira ) - Kyushu University Graduate School of Medical Sciences Department of Pediatric Surgery, Reproductive and Developmental Medicine
 ( Masumoto Kouji ) - Kyushu University Graduate School of Medical Sciences Department of Pediatric Surgery, Reproductive and Developmental Medicine
 ( Matsuura Toshiharu ) - Kyushu University Graduate School of Medical Sciences Department of Pediatric Surgery, Reproductive and Developmental Medicine
 ( Pudjiadi Antonius Hocky ) - Universitas Indonesia Faculty of Medicine Cipto Mangunkusumo Hospital Department of Child Health
 ( Taguchi Tomoaki ) - Kyushu University Graduate School of Medical Sciences Department of Pediatric Surgery, Reproductive and Developmental Medicine

Abstract


An 18-year-old woman with annular pancreas and duodenal duplication presented with recurrent acute pancreatitis and underwent a resection of duodenal duplication. However, the patient experienced recurrent abdominal pain after resection. Abdominal computed tomography and magnetic resonance imaging showed a dilatation of the peripheral pancreatic duct and stenosis and malformation of both the Wirsung's and Santorini's duct due to multiple stones. The modified puestow procedure was performed. The main pancreatic ducts in the body and tail were opened, and the intrapancreatic common bile duct was preserved. A Roux-en-Y pancreatico-jejunostomy was performed for reconstructing the pancreaticobiliary system after removing the ductal protein plug. The patient experienced no abdominal pain, no significant elevation of the serum amylase and lipase levels, and no stone formation during the 2 years of follow-up. This procedure is considered to be beneficial for pediatric patients with chronic pancreatitis due to annular pancreas and duodenal duplication.

키워드

Modified puestow procedure; Lateral pancreatico-jejunostomy; Chronic pancreatitis; Recurrent abdominal pain; Duodenal duplication; Annular pancreas

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