Frey procedure for chronic pancreatitis in adolescent with recurrent bleeding: a case report

Abstract

Background: Chronic pancreatitis is rare in children and commonly unresponsive to medical therapy, associated with a higher complication and mortality rate. Abdominal pain is the major presenting symptom. Case presentation: A 13-year-old female presented with severe abdominal pain and massive hematemesis recurred several times during a period of 3 months, always crescendo-decrescendo followed by hemorrhage - starting once every 3-4 weeks and gradually became more frequent. Upper endoscopy found an active bleeding came out of the papilla Vater, with subacute bleeding intra-pseudocyst, suggestive of chronic arterial injury at the splenic artery (4 cm from the proximal part of coeliac trunk) and no dilatation of Intra- and extra-biliary was showed in MRCP. Results: Surgical exploration revealed a chronic pancreatitis with multiple pancreatic duct stone and pseudocyst. A pseudoaneurysm also found in the pseudocyt. Frey procedure was carried out. The post-operative course went uneventfully, and patient was discharged on post-operative day 14. Conclusions: Surgical failures in the management of chronic pancreatitis have been attributed to inadequate decompression of the head of the pancreas, The Frey procedure adds anterior resection of the head of the pancreas to the LPJ and was created to improve decompression of the head of the gland, with relatively lower morbidity compared to Beger procedure.