Presentation
History of chronic pancreatitis, MRCP revealed lower CBD stricture and Pancreatic duct obstruction. CBD and Pancreatic duct stenting was technically not possible at ERCP. Patient is taken for Puestow's Procedure.
Patient Data
Intra-operative sonography of pancreas and lower end of CBD has been done.
It reveals dilated CBD; No mass lesion at the lower end.
The diameter of pancreatic duct = 4.1mm. Caliber on MRCP was 11mm.
Debris is seen within the pancreatic duct - representing infected contents.
Dense pancreatic parenchymal calcifications of chronic pancreatitis.
Case Discussion
During the exposure of the pancreas, pus came out on the pancreatic surface.
Since the caliber of the pancreatic duct was only 4.1mm - pancreaticojejunostomy was abandoned and only a choledocho-duodenostomy performed.
The patient is recovering well after the surgery.
Note the dense pancreatic parenchymal calcifications of chronic pancreatitis.
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