Successful partial pancreatotomy as a salvage procedure for massive intraoperative bleeding during head coring for chronic pancreatitis. Report of a case

Chronic pancreatitis is a continuous inflammatory disease of the pancreas resulting in scarring and fibrosis with consequent decline in exocrine and endocrine function. The inflammatory process leads to the development of a head mass, and strictures and stones in the pancreatic duct which present as pain, or loco regional complications such as duodenal obstruction and biliary obstruction. The gold standard for the treatment of pain and loco regional complications remains surgery, which is usually a combination of drainage and partial resection (coring). This can be hazardous due to adhesions, inflammation or portal hypertension. We report a case in which severe bleeding from the pancreatic duct was encountered during a Frey procedure. It was from the superior mesenteric vein/splenic vein confluence and would have warranted a Whipple procedure. We describe a pancreatotomy for exposure and control of the bleeding, with re-suturing of the cut pancreas and completion of the pancreaticojejunostomy.