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Case Reports
. 2024 Oct 3;2024(10):rjae614.
doi: 10.1093/jscr/rjae614. eCollection 2024 Oct.

Puestow surgery in a SPINK mutation chronic pancreatitis: a rare case report

Paola Solis-Pazmino  1 , Iván Hernandez  2 , Erika Gordon  2 , Estefania Clavijo  3 , Estefania Alvarado  1 , Eddy Lincango  4 , Andrés Cedeño  1   5
Affiliations
Case Reports

Puestow surgery in a SPINK mutation chronic pancreatitis: a rare case report

Paola Solis-Pazmino et al. J Surg Case Rep. .

Abstract

This case report highlights the clinical presentation and surgical management of a 27-year-old man with recurrent pancreatitis attributed to a homozygous SPINK1 (N34S) mutation. The patient, who experienced multiple hospital admissions, underwent extensive diagnostic evaluations, including imaging and genetic testing, confirming the hereditary nature of his condition. Despite unsuccessful endoscopic interventions, a laparoscopic Puestow procedure was performed, aiming to alleviate symptoms and improve pancreatic drainage. Postoperatively, the patient's recovery was successful, and he was discharged with supplemental pancreatic enzyme therapy. The differential diagnosis included autoimmune pancreatitis and non-hereditary chronic pancreatitis. This case underscores the challenges and considerations in the diagnosis and management of hereditary pancreatitis associated with SPINK1 mutations, emphasizing the role of surgical interventions for selected cases.

Keywords: SPINK1 mutation; chronic pancreatitis; laparoscopic Puestow pancreatectomy.

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Conflict of interest statement

The authors declare that there is no conflict of interest.

Figures

Figure 1
Figure 1
Abdominal ultrasound shows a diffuse dilation of the main pancreatic duct.
Figure 2
Figure 2
Abdominal computed tomography shows a diffuse dilation of the main pancreatic duct and Santorini duct, as well as dilation of secondary ducts. There are stones in the main pancreatic duct in the head region. Also, there is a reduction in the thickness of the pancreatic parenchyma, associated with small intervening calcifications, possibly due to chronic pancreatitis.
Figure 3
Figure 3
Endoscopic retrograde pancreatography shows an unsuccessfully cannulated pancreatic duct.
See this image and copyright information in PMC

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