A 35 years- old man without comorbidities presents an epigastrium severe pain that irradiates for back (3 years). He denies use of alcohol, hypertrigliciredemia, abuse of drugs, hypercalcemia, pancreatic cancer or cholelithiasis. She realized several exams as CT where was observed tail pancreatic mass with 4 X 3 cm of diameter without as wirsung dilatation as calcifications, this finding was also observed in MRI. As ERCP as Cholangio MRI are normals.He realized echo-endoscopy that confirmed this mass, but discarded any finding of neoplasm. Biopsy was realized, showing at histopathology an absence of tumoral findings from pancreatic neoplasms. Only severe inflamation with large fibrosis and destruction of canalicules was observed. Auto-imune pancreatitis by either imuno-histochemical analysis or serical levels of igg4 and NAF was discarded.
This patient still presents severe pain in daily use of opioids. The question is: Is there a place for pancreatic resection in this setting?
There would be a few indications for resection.
1. Diagnostic uncertainty - unable to exclude a mlignancy with certinty.
2. Ongoing symptoms affecting QoL despite optimal medical / endoscopic management.
Dear Colin. At first, thanks a lot for your comentaries. I fully agree with you. So, I think that there are these both indications which you wrote.
We started by video where we found hard adherences in all abdominal cavity. So , we underwent by open access. The intraoperative findings evidenced a tumoral mass in tail of pancreas which was firmly adhered to the splenic artery. Therefore, we proceded a distal pancreatectomy with splenectomy. The patient recovered without complications. The histopathological findings showed a chronic pancreatitis. He showed improvement in his pain.