Successful Laparoscopic Pancreaticojejunostomy with Splenectomy for Acute-on-Chronic Pancreatitis

Chief Complaints

A 38-year-old male patient with a body mass index (BMI) of 18 presented to the Surgical Gastroenterology Department at PACE Hospitals, Hitech City, Hyderabad, with complaints of recurrent episodes of upper abdominal pain for the past few months.

The patient had no significant past medical or surgical history. He had no known chronic illness, previous major surgery, or medication allergy.

On examination, the patient was conscious, coherent, oriented, and hemodynamically stable. Abdominal examination revealed mild tenderness in the upper abdomen without guarding, rigidity, or signs of acute peritonitis. The remaining systemic examination was normal.

Upon admission to PACE Hospitals, following a detailed clinical assessment, the Surgical Gastroenterology team evaluated the patient for recurrent upper abdominal pain that had been present for the past few months. His previous CT and contrast-enhanced CT findings were reviewed as part of the evaluation.

Imaging revealed acute-on-chronic pancreatitis with a complex pancreatic pseudocyst involving the head and neck of the pancreas, along with moderate ascites. The diagnosis was established based on the patient’s clinical presentation, imaging findings, and further evaluation performed after admission.

Routine investigations, including complete blood count, serum biochemistry, pancreatic function tests, and other preoperative assessments, were performed to evaluate the patient’s overall medical condition and fitness for surgery. These investigations also assisted the surgical team in planning the appropriate treatment.

Based on the confirmed diagnosis, the patient was advised to undergo Acute-on-Chronic Pancreatitis with Pancreatic Pseudocyst Treatment in Hyderabad, India, under the expert care of the Surgical Gastroenterology Department.

After detailed consultation with Dr. Govind Verma, Dr. M Sudhir, Dr. Prashanth Sangu, and Dr. Suresh Kumar S, a comprehensive clinical evaluation was performed to determine the most appropriate treatment approach for the patient presenting with recurrent upper abdominal pain. The patient’s previous CT and contrast-enhanced CT findings were reviewed, and further investigations and pre-anaesthetic assessment were carried out to evaluate his fitness for surgery.

Considering the patient’s clinical presentation and imaging findings, the diagnosis of acute-on-chronic pancreatitis with a complex pancreatic pseudocyst involving the head and neck of the pancreas, moderate ascites, pancreatic duct stones, and pancreatic duct dilatation was confirmed. Routine laboratory investigations and standard preoperative assessments were performed to evaluate his overall medical condition and plan the surgical procedure.

Based on the clinical assessment, imaging findings, and obstructed dilated pancreatic duct, it was determined that laparoscopic pancreaticojejunostomy with splenectomy was the most appropriate management strategy. Pancreaticojejunostomy was planned to improve pancreatic duct drainage, relieve ductal pressure, manage the obstructing stones, and reduce recurrent abdominal pain. Splenectomy was included based on the extent of the associated disease and intraoperative findings.

The patient and his family members were counselled regarding the diagnosis, proposed surgical procedure, expected benefits, potential risks, postoperative drain care, recovery, and the importance of adhering to medications, dietary advice, and scheduled follow-up for optimal outcomes.

Following the clinical decision, the patient was scheduled for Laparoscopic Pancreaticojejunostomy with Splenectomy in Hyderabad at PACE Hospitals under the expert care of the Surgical Gastroenterology Department.

The following steps were carried out during the procedure:

• Patient Preparation and Laparoscopic Access: After preoperative investigations, anaesthetic clearance, and informed consent, the patient was taken up for surgery under general anaesthesia. The abdomen was prepared under strict aseptic precautions. Laparoscopic ports were placed to access the pancreas, spleen, and surrounding structures.

• Pancreatic Assessment and Exploration: The pancreas and nearby tissues were carefully examined during surgery. An intrapancreatic pseudocyst involving the head of the pancreas was identified, along with a firm pancreatic texture. The main pancreatic duct was dilated, with multiple stones present inside it.

• Pancreatic Duct Opening and Stone Removal: The main pancreatic duct was identified and opened longitudinally along the affected portion. Multiple pancreatic duct stones and obstructing material were carefully removed. The duct was cleared adequately to improve the drainage of pancreatic secretions.

• Pancreaticojejunostomy and Splenectomy: A loop of the jejunum was connected to the opened pancreatic duct to create a side-to-side pancreaticojejunostomy. This allowed pancreatic secretions to drain into the small intestine and reduced pressure within the duct. Splenectomy was also performed based on the associated disease and intraoperative findings.

• Drain Placement and Closure: After ensuring adequate haemostasis and checking the surgical connection, drains were placed near the pancreas and splenic fossa. A percutaneous catheter drainage tube was maintained to drain the associated ascitic fluid. The laparoscopic ports were removed, and the incisions were closed in layers.

The postoperative period was uneventful. The patient was closely monitored for vital signs, abdominal symptoms, drain output, bowel function, and tolerance to oral intake. Intravenous treatment was provided for infection prevention, pain control, gastric protection, hydration, and supportive care. A liquid diet was started from the second postoperative day, and the splenic fossa drain was removed after satisfactory recovery.

Upon discharge, the patient was prescribed oral medications to prevent infection, reduce pain and inflammation, protect the stomach, relieve indigestion, and maintain regular bowel movements. Additional supportive treatment was advised as required during recovery.

The patient was advised to take all prescribed medicines, keep the wound and drain clean, and attend follow-up as scheduled. Immediate medical attention was recommended for fever, severe abdominal pain, vomiting or unusual drain output.

The patient was advised to report to the emergency ward at PACE Hospitals in case of fever, abdominal pain, wound discharge, bleeding, vomiting, severe pain, drain-related concerns, or any other emergency symptoms.

The patient was advised to return for a follow-up visit with the Surgical Gastroenterologist in Hyderabad at PACE Hospitals after five days for wound and drain assessment, recovery evaluation, and further postoperative guidance.

This case highlights the successful use of laparoscopic pancreaticojejunostomy with splenectomy in managing acute on chronic pancreatitis with a complex pseudocyst and pancreatic duct stones. Timely surgical intervention and postoperative care helped the patient recover without complications.