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Exocrine Pancreatic Insufficiency: Postoperative Complication Emerging Decades after Surgery?
João Pedro Santos DE Lança Pereira1, Elisa Veigas1, Eurico Oliveira1
1Department of Internal Medicine, ULS Viseu Dão-Lafões, Viseu, Portugal.
Maedica
|August 29, 2025
Summary
This case report highlights a rare instance of exocrine pancreatic insufficiency (EPI) appearing 29 years after surgery. Prompt enzyme replacement and nutritional support effectively resolved symptoms and deficiencies in the patient.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Endocrinology
Background:
- Exocrine pancreatic insufficiency (EPI) results from insufficient pancreatic enzymes, causing malabsorption and symptoms like weight loss and steatorrhea.
- While EPI often follows chronic pancreatitis or pancreatic surgery, its delayed onset is infrequently documented.
Purpose of the Study:
- To report a unique case of EPI manifesting 29 years post-pancreaticoduodenectomy.
- To emphasize the diagnostic challenges and prolonged latency associated with post-surgical EPI.
Main Methods:
- A 71-year-old female patient presented with symptoms suggestive of malabsorption 29 years after pancreaticoduodenectomy.
- Diagnostic workup excluded other etiologies, confirming EPI through severe fecal elastase reduction.
- Treatment involved enzyme replacement, vitamin supplementation, and diuretics.
Main Results:
- The patient exhibited fatigue, weight loss, edema, diarrhea, anemia, hypoproteinemia, and vitamin deficiencies.
- Treatment led to symptom resolution and normalization of laboratory parameters within 12 months.
- The 29-year delay in EPI onset is among the longest documented.
Conclusions:
- This case underscores the potential for prolonged latency in post-surgical EPI, posing diagnostic difficulties.
- Long-term vigilance is crucial for patients with a history of pancreatic surgery.
- Timely enzyme supplementation and nutritional management are effective in reversing EPI-related symptoms and deficiencies.
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