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Insuficiencia pancreática exocrina: ¿Complicación postoperatoria que surge décadas después de la cirugía?
João Pedro Santos DE Lança Pereira1, Elisa Veigas1, Eurico Oliveira1
1Department of Internal Medicine, ULS Viseu Dão-Lafões, Viseu, Portugal.
Maedica
|August 29, 2025
Resumen
Este informe de caso destaca un raro caso de insuficiencia pancreática exocrina (EPI) que aparece 29 años después de la cirugía. El rápido reemplazo de enzimas y el apoyo nutricional resolvieron efectivamente los síntomas y las deficiencias en el paciente.
Área de la Ciencia:
- Gastroenterología
- Oncología quirúrgica
- Endocrinología
Sus antecedentes:
- La insuficiencia pancreática exocrina (EPI) es el resultado de una insuficiencia de las enzimas pancreáticas, causando malabsorción y síntomas como pérdida de peso y esteatorrea.
- Si bien la EPI a menudo sigue a la pancreatitis crónica o a la cirugía pancreática, su aparición tardía se documenta con poca frecuencia.
Objetivo del estudio:
- Para reportar un caso único de EPI que se manifiesta 29 años después de la duodenectomía pancreática.
- Hacer hincapié en los desafíos de diagnóstico y la latencia prolongada asociada con el EPI posquirúrgico.
Principales métodos:
- Una paciente de 71 años presentó síntomas sugestivos de malabsorción 29 años después de la duodenectomía pancreática.
- El diagnóstico excluyó otras etiologías, confirmando la EPI a través de una severa reducción de la elastasa fecal.
- El tratamiento consistió en reemplazo de enzimas, suplementos vitamínicos y diuréticos.
Principales resultados:
- El paciente exhibió fatiga, pérdida de peso, edema, diarrea, anemia, hipoproteinemia y deficiencias de vitaminas.
- El tratamiento condujo a la resolución de los síntomas y a la normalización de los parámetros de laboratorio en un plazo de 12 meses.
- El retraso de 29 años en la aparición de EPI es uno de los más largos documentados.
Conclusiones:
- Este caso subraya el potencial de latencia prolongada en la EPI posquirúrgica, lo que plantea dificultades de diagnóstico.
- La vigilancia a largo plazo es crucial para los pacientes con antecedentes de cirugía pancreática.
- La suplementación enzimática oportuna y el manejo nutricional son efectivos para revertir los síntomas y deficiencias relacionados con la EPI.
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