[Spleen preserving subtotal pancreatectomy for chronic pancreatitis: case report]

Subtotal pancreatectomy is an exceptional solution for the pain in chronic pancreatitis affecting the whole pancreas, which evolves with non-dilated Wirsung duct or in cases in which drainage procedures fail to achieve improvement of symptoms. If it is possible to avoid splenectomy, this type of surgical procedure enters in the modern concept of treatment of chronic pancreatitis named "organ sparing", basically being a Beger procedure combined with a distal pancreatectomy with spleen preservation. The case reported here is of a young male (29 years old) with idiopathic chronic pancreatitis progressively affecting the whole pancreas which had the main symptom the resistant pain to medical and non-resectional surgical treatment (left thoracoscopic splanchnicectomy at 4 years after diagnosis); at 8 years after diagnosis the pain becomes almost permanent, a cystic tumor is evolving in the body of pancreas and CA 19-9 tumor marker reaches values over 100 U/mL. In this context it was decided to perform a spleen-preserving subtotal pancreatectomy 95% (near total pancreatectomy) as the last therapeutic resource. The postoperative course was complicated with a biliary leak treated conservative and the patient was discharged in the 54th postoperative day. After 12 months the results are good regarding pain control, serum glucose levels and quality of life.