Pancreatolithiasis in a 55-year-old woman treated surgically with a modified Puestow procedure: a case report

Pancreatolithiasis is the formation of stones in the pancreatic parenchyma, side branches, or the pancreatic ducts. The prevalence of the disease is 0-4 per 1000 people worldwide. It is found in 50-90% of people with chronic pancreatitis and is strongly linked to the condition.

A 55-year-old female patient presented to our hospital with the complaint of worsening epigastric pain of 2 weeks' duration. The patient had been experiencing pain for the past 7 years. An abdominal computed tomography scan showed whole-length pancreatic duct beaded-type dilatation and a hyperdense lesion on the proximal pancreatic duct. With the diagnosis of pancreatolithiasis, a modified Puestow's procedure was performed, with an intraoperative finding of a pancreatic stone of size ≈4 cm × 1.5 cm at the proximal body of the pancreas with a dilated main pancreatic duct. The postoperative course and follow-up were uneventful.

An increase in pancreatic intraductal pressure, which results from increased mucin production, is thought to be the primary mechanism of stone formation. Treatment modalities for pancreatolithiasis include (1) endoscopic, (2) extracorporeal shock wave lithotripsy (ESWL), and (3) surgical options. Stone fragmentation by ESWL has become the first-line and the mainstay of treatment for the majority of patients with pancreatic duct stones, mainly for stones >0.5 cm in size. One surgical option for treating pancreatolithiasis or chronic pancreatitis is modified Puestow's surgery.

Though the recommended first-line treatment for large pancreatolithiasis (>0.5 cm) is ESWL, surgery is one option for management in setups where resources are limited.