38 year old non alcoholic diagnosed to have recurrent pain due to chronic tropical pancreatitis underwent PJ(longitudinal) 8 months ago.Relapse of his symptoms in 3to4 months after surgery.Investigations about a month ago showed elevated Amylase and Lipase,CT reported to show dilated distal PD and non visualized duct at the level of PJ.Options mentioned were Endotherapy(pd sphincterotomy,stenting),Revision surgery and coeliac ganglion block.Prior to these a good MRCP,
Apart from CT done, another non invasive exams like, Magnetic Ressonance, abdominal Ultrasound with enphasy could elucidate doubts of any pathophysiological state of biliary ways or obstructive bile stones along with laboratory Alcaline phosphatase could be also of help.
Coeliac plexus block for chronic pain is not useful as there will be reinnervation and they will get the pain back. I think it depends on surgery and where the anastomoses is and whether there is a stricture there. MRCP would be helpful.
It seems as if you did all the right things. However, some patients do not respond or develop differently. The longitudinal opening of the MPD might not sufficient. This patient might need a full pancreatic head resection.
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