Chronic Idiopathic Pancreatitis and Pancreaticolithiasis

Chronic pancreatitis (CP) is an inflammatory syndrome that causes irreversible damage and loss of pancreatic function. A late complication is pancreatolithiasis, which exacerbates pain due to intraductal hypertension. In this work, we demonstrate that given the availability of different non-surgical treatment methods, if we are in the presence of dilated ducts, longitudinal pancreaticojejunostomy (Puestow procedure) is the best surgical drainage option. The clinical study is presented through the case of a 56-year-old man with idiopathic CP and recurrent lithiasis. The diagnosis was confirmed by magnetic resonance cholangiopancreatography. A lateral pancreaticojejunostomy was performed according to Puestow with Roux-Y anastomosis for ductal decompression. The intervention resolved ductal hypertension by allowing the drainage of liths. The patient was discharged after 10 days with improvement in liver profile and pancreatic enzymes, remaining asymptomatic during six months of follow-up. The Puestow procedure is a current and highly effective technique for refractory lithiasis CP. It is feasible in patients with stones larger than 2 mm, allowing complete functional recovery and preventing secondary complications.