LAUSR

successful in controlling pain and patients are at risk of suffering further morbidity. Endoscopic and surgical management are considered the mainstay of treatment with the choice between the two often coming down to the ductal anatomy. The presence of distal pancreatic duct stones can make endoscopic therapies less effective and some believe this to be an indication for surgical management. Endoscopic management may also be limited in Australian endoscopic units by a lack of familiarity with the condition. The decision of our hepatobiliary specialist was to progress to a modified Puestow’s procedure (lateral pancreaticojejunostomy) as she was suffering from ongoing pain as well as early signs of pancreatic insufficiency. Most sources reviewed agree that decompressive procedures provided effective pain management (in the order of 70–90%), prevention or potential reversal of pancreatic endocrine and exocrine dysfunction. The significantly increased risk of pancreatic cancer seen with all forms of chronic pancreatitis is also observed in tropical pancreatitis. In our case, surgery was considered necessary primarily not only to treat the patient’s refractory pain but also in an attempt of reducing future morbidity and complications given her young age, as well as hopefully reducing her future risk of pancreatic cancer. References