My brother has chronic calcific pancreatitis. Does it need to be removed surgically?

Question

Hello doctor,

My brother has stones in the pancreas, and the report says chronic calcific pancreatitis. Some doctors say surgery is required, and some say it is not required unless my brother is in pain. Could you please let me know by removing stones, he can become normal without depending on the medicine?

The report says as follows: The pancreas is completely atrophied and is replaced by fat. There are multiple intraductal and peripheral calcifications noted, which show conglomeration in the head and uncinate process region of the pancreatic parenchyma.

The pancreatic duct is grossly dilated and measures 18 mm. Peripancreatic fat planes are preserved. No evidence of pseudocyst. No evidence of vascular complications. No evidence of suspicious mass lesions.

He is currently on Enzar-HS (1-1-0-1), RLS 9G (0-0-0-1), Esogress (1-0-0-0), Uprise D3 (1-0-0-0), and Bevon.

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I have seen the reports you attached (attachment removed to protect patient identity). The clinical history i.e diarrhea and CT (computed tomography ) scan findings are suggestive of chronic calcific pancreatitis which is an entity that occur in tropical areas such as India and middle east countries.

Unfortunately with such advanced atrophy of pancreas (shrinking pancreas) diarrhea and other symptoms of malabsorption are inevitable. The malabsorption means loss of absorption of foods in the gut and resultant weight loss.

The approach to chronic calcific pancreatitis is a little different. Since the stones are two many they cannot be dealt in a single or two session of endoscopy. I suggest you to control his diarrhea with medications, but increase the dose to two tablets twice daily with meals. If diarrhea still not settled consider giving him injection Octreotide 50 mcg (somatostatin) twice daily via subcutaneous route. The surgery is the definitive therapy once he has pain because of these stones not otherwise.

See me after 1 week if his diarrhea does not settle or he develops pain.

Thank you.

Answer 2

Hello,

Welcome back to icliniq.com.

Unfortunately, the pancreas cannot be brought to its normal form and texture. These medications have to be continued for the rest of life. They are enzymes supplements which otherwise secreted by the pancreas. Since the pancreas is no more functional, these enzyme supplements would replenish and would help in the digestion of the food.

Your question of whether surgery can resolve the issue is honestly not in my domain. A surgeon is the best person to decide about this. Given the location of pancreas and the complexity of surgeries performed in chronic calcific pancreatitis, it is very difficult to say that it would be completely beneficial or not.

I want you to update me about your symptoms, if not controlled then, would consider add on therapy. You should require a regular follow up with a gastroenterologist.

Thank you.