Pancreatolithiasis with Puestow Procedure in Rural Hospital: Case Report
Dewa Putu Satria Juristiasa¹*, Ida Bagus Wisnu Parbawa Kusuma², Herman Wambrauw³
Abstract
Background: Pancreatolithiasis represents a significant challenge in gastroenterological surgery, particularly when complicated by metabolic disorders and lifestyle factors. This rural setting often results in limited access to specialized medical care, leading to delayed diagnosis and treatment for conditions such as pancreatolithiasis. The coexistence of uncontrolled diabetes mellitus and chronic alcoholism creates a complex clinical scenario that can significantly impact surgical outcomes and post-operative recovery. Understanding these interactions is crucial for optimal patient management and risk stratification in surgical decision-making. Case presentation: A 22-year-old male presented with severe hyperglycemia (blood glucose 768 mg/dL) and generalized weakness, complicated by a two-year history of poorly controlled type 2 diabetes mellitus and chronic alcoholism. Diagnostic imaging revealed multiple pancreatic calculi, necessitating a modified Puestow procedure. The postoperative course was marked by severe complications, including metabolic derangements, coagulopathy with severe thrombocytopenia, and respiratory failure requiring tracheostomy. Discussion: This case highlights the complex interplay between pancreatolithiasis, diabetes mellitus, and chronic alcoholism in young adults. The rapid deterioration despite aggressive medical management underscores the importance of comprehensive pre-operative risk assessment and metabolic optimization. The case demonstrates the potential complications of major pancreatic surgery in patients with multiple comorbidities. Conclusion: Pancreatolithiasis is a challenge to diagnose, accurate diagnosis and open surgery is the definitive therapy. Early recognition of high-risk factors, careful patient selection, and aggressive pre-operative optimization are crucial in managing complex cases of pancreatolithiasis.
Keywords
pancreatolithiasis; modified puestow procedure; diabetes mellitus; surgical complications.
Cite This Article
Juristiasa, D. P. S., Kusuma, I. B. W. P., Wambrauw, H. (2025). Pancreatolithiasis with Puestow Procedure in Rural Hospital: Case Report. International Journal of Scientific Advances (IJSCIA), Volume 6| Issue 1: Jan-Feb 2025, Pages 174-178 URL: https://www.ijscia.com/wp-content/uploads/2025/02/Volume6-Issue1-Jan-Feb-No.839-174-178.pdf
Volume 6 | Issue 1: Jan – Feb 2025
