THE CASE OF SURGICAL TREATMENT OF CHRONIC (CEPHALIC) PANCREATITIS

This paper describes a retrospective analysis of the duodenum-preserving pancreatic head resection case according to Beger’s operation in the conditions of a multi-specialty hospital AO MSCH “Neftyanik” in the city of Tyumen. In November 2018, a 39-year-old patient was admitted on an emergency basis with complaints of persistent, intense pain in the epigastrium, right and left hypochondrium. The principal diagnosis: Chronic (cephalic) pancreatitis. The cyst of the pancreatic head. The secondary diagnosis: stage 2 arterial hypertension, grade 3. CHF 0 FC1 (NYHA). In November 2018, due to the pain syndrome, the patient called the ambulance team and was taken to the hospital on duty. Since March 2018, the loss of body weight was 20 kg, the weight at admission was 42 kg. According to the ultrasound data of the abdominal cavity, diffuse parenchymal changes of the liver, pancreas, echophenomenon of cholecystitis, choledochoectasia, and the cyst of the pancreatic head were observed. CT-MSCT detected pancreatitis. Due to the inefficiency of conservative therapy, progressive cachexia (42 kg), persistent pain syndrome and suspected oncological process, it was decided for the patient to undergo operative treatment the volume of which was planned to be determined intraoperatively. During the operation, a cytohistological examination of the head of the pancreas was carried out, and the oncological process was excluded. During the incision and revision of the main pancreatic duct (Wirsung duct), a narrow duct of up to 2 mm was verified. Given the narrowness of the Wirsung duct and the negative result of cytohistological examination for oncopathology, it was decided to conduct Beger’s operation. The duration of the operation was 4 hours 30 minutes. The intraoperative blood loss was 100 ml. Neither intraoperative nor postoperative complications were observed. During the dynamic observation, the patient had a subfebrile temperature with a tendency to decrease on the third day and complete normalization on the sixth day. On the first day, there was a progressive decrease in the amylase of the effusion fluids from 2600 units to the absence of amylase on the eighth day. The patient was discharged on the 11th day from the moment of hospitalization in a satisfactory condition with the elimination of pain syndrome after eating and normal paraclinical indicators.