Pt. with chronic pancreatitis gives chain of lakes appearance in ERCP examination. Management is:
Ans. is 'c' ie. side to side pancreatico jejunostomy Areas of ductal dilatation alternating with areas of ductal stenosis are common finding in alcoholic patients who have severe chronic pancreatitis. This type of duct obstruction cannot be relieved by a sphincteroplasty because of multiple areas of stenosis along the duct. Although total pancreatectomy would be a beneficial approach, moality and morbidity rate with this procedure are extremely high. Thus the procedure of choice in this pt. is side to side pancreaticojejunostomy in which the duct is opened longitudinally through the chain of lakes. A Roux-en-Y limb of jejunum should then be brought up for anastomosis with the opened pancreas in side-to-side fashion.
Total pancreatectomy
Sphincteroplasty
Side to side pancreatico jejunostomy
Resecting the tail of pancreas and performing a pancreatojejunostomy