Successful Frey’s Procedure for Chronic Calcific Pancreatitis in a 19 Y.O. Male

Chief Complaints

A 19-year-old male patient with a body mass index (BMI) of 18 presented to the Gastroenterology Department at PACE Hospitals, Hitech City, Hyderabad, with recurrent episodes of severe pain in the epigastric region for the past ten years. The pain was severe enough to require intravenous pain-relieving medications for symptomatic relief. He did not report oily stools, jaundice, joint pain, or swelling in the neck.

The patient had secondary hyperparathyroidism related to vitamin D deficiency, with elevated parathyroid hormone levels. An endocrinologist’s opinion was obtained before surgery. No other significant comorbidities, previous surgeries, or relevant treatment history were reported.

On examination, the patient was conscious, coherent, oriented, and hemodynamically stable. Abdominal examination was carried out to assess the site and severity of pain, with no signs of jaundice, abdominal distension, or acute peritonitis. There was no swelling over the neck or evidence of joint inflammation. The remaining systemic examination was within normal limits.

Upon admission to PACE Hospitals, following a detailed clinical assessment, the Gastroenterology team evaluated the patient for recurrent episodes of severe epigastric pain requiring intravenous pain-relieving medications, along with a review of his relevant medical history.

Clinical evaluation and imaging findings were suggestive of chronic calcific pancreatitis, a long-standing inflammatory condition associated with pancreatic calcification, ductal obstruction, and recurrent abdominal pain.

Further investigations included contrast-enhanced computed tomography, magnetic resonance imaging with magnetic resonance cholangiopancreatography, lipid profile testing, and routine laboratory investigations. These assessments helped identify chronic structural changes in the pancreas and confirm the diagnosis.

Based on the confirmed diagnosis, the patient was advised to undergo Chronic Calcific Pancreatitis Treatment in Hyderabad, India, under the expert care of the Gastroenterology Department.

After a detailed consultation with Dr. Govind Verma (Interventional gastroenterologist, transplant hepatologist, pancreatologist and endosonologist), and cross consultation with Dr. Tripti Sharma (endocrinologist), a comprehensive evaluation was performed to determine the most appropriate diagnostic and therapeutic approach.

Considering the patient’s history of recurrent severe epigastric pain requiring intravenous pain-relieving medications and clinical findings suggestive of chronic pancreatitis, further evaluation confirmed chronic calcific pancreatitis with a dilated pancreatic duct and an obstructing stone near the neck of the pancreas. Laboratory investigations also revealed secondary hyperparathyroidism associated with vitamin D deficiency.

Based on the clinical assessment, imaging findings, and preoperative evaluation, it was determined that Frey’s procedure was the most appropriate and effective management strategy. This approach was chosen to core the diseased pancreatic head, open and decompress the pancreatic duct, remove the obstructing stone, improve pancreatic drainage, and provide long-term relief from recurrent abdominal pain while preserving the duodenum and common bile duct.

The patient and his family members were counselled regarding the diagnosis, clinical findings, planned procedure, and the importance of postoperative care and follow-up.

Following the decision, the patient was scheduled for Frey’s Procedure in Hyderabad at PACE Hospitals, under the expert care of the Gastroenterology Department.

The following steps were carried out during the procedure:

• Patient Preparation and Anaesthesia: After completing the required preoperative investigations and pre-anaesthetic assessment, the patient was taken up for surgery. Informed consent was obtained, and general anaesthesia was administered under strict aseptic precautions. The abdomen was prepared and positioned for safe access to the pancreas.

• Abdominal Exploration and Pancreatic Assessment: The abdominal cavity was opened, and the pancreas was carefully exposed. The pancreas appeared firm and atrophic, consistent with chronic pancreatitis. The main pancreatic duct was dilated, and a large stone was identified near the neck of the pancreas.

• Opening of the Pancreatic Duct and Stone Removal: The main pancreatic duct was identified and opened along its length to relieve obstruction and reduce pressure. The stone near the pancreatic neck was carefully removed. The duct was examined to ensure that adequate clearance and drainage had been achieved.

• Coring of the Pancreatic Head: The diseased and fibrotic tissue in the head of the pancreas was carefully cored out. The duodenum and common bile duct were preserved during this step. This helped reduce inflammatory pressure and improve drainage from the pancreatic head.

• Roux-en-Y Pancreaticojejunostomy and Closure: A Roux-en-Y loop of the jejunum was connected to the opened pancreatic duct through a lateral pancreaticojejunostomy. The connection was completed using a continuous interlocking suture technique to allow free drainage of pancreatic secretions. After confirming haemostasis, a drain was placed, and the abdomen was closed in layers.

The patient had an uneventful postoperative recovery and was closely monitored in the general observation ward. A liquid diet was started on the first postoperative day and gradually continued according to tolerance. During the hospital stay, he received intravenous medications for infection prevention, pain control, gastric protection, hydration, and supportive care. An ultrasound performed during recovery showed no intra-abdominal fluid collection, allowing safe drain removal before discharge, and the patient remained hemodynamically stable without postoperative complications.

Upon discharge, the patient was prescribed oral medications to reduce postoperative pain and inflammation, protect the stomach lining, prevent constipation, and correct vitamin D deficiency. The prescribed treatment was intended to support wound healing, improve comfort, and aid recovery after surgery. The patient and his family were advised regarding the correct dosage, timing, duration, and safe use of all medications.

The patient was advised to eat small, low-fat meals, stay well hydrated, avoid alcohol and smoking, and keep the surgical wound clean and dry during recovery.

The patient was informed to contact the emergency ward at PACE Hospitals in case of any emergency or development of symptoms such as severe abdominal pain, persistent vomiting, fever, jaundice, abdominal swelling, or any unusual discharge from the surgical wound.

The patient was advised to return for a follow-up visit with the Gastroenterologist in Hyderabad at PACE Hospitals after 1 week.

This case highlights the successful management of chronic calcific pancreatitis in a young male patient through Frey’s procedure. The surgery helped decompress the pancreatic duct, remove the obstructing stone, and improve pancreatic drainage. The patient recovered well without postoperative complications and was discharged in a stable condition with appropriate dietary, medication, and recovery advice.