Pancreatic Exocrine Insufficiency with Systemic Edema after Pancreaticoduodenectomy: A Case Report

Context Pancreatic exocrine insufficiency is caused by primary diseases such as chronic pancreatitis, cystic fibrosis, and main pancreatic duct occlusion due to a tumor, or it may develop because of pancreatectomy. Steatorrhea or diarrhea, which occurs along with inadequate digestion/absorption of fat, often leads to a diagnosis of pancreatic exocrine insufficiency. Case report An 81-year-old man presented to our outpatient department with systemic edema. He had undergone pylorus-preserving pancreaticoduodenectomy for cancer of the head of the pancreas (pT3N1M0, stage III) 3 months previously. No pyrexia, nausea, vomiting, appetite impairment, or dyspnea was observed. Although fecal fat staining yielded negative results, lower gastrointestinal endoscopy indicated occasional lipid droplets in the large intestine. Neutral fat indigestion and protein absorption impairment were sus pected due to pancreatic exocrine insufficiency. Therefore, LipaCreon®?a high-titer pancreatin?was administered for pancreatic enzyme replacement therapy. After 2 months, no residual edema was observed, and the serum albumin level returned to normal. Conclusions We report a case wherein the patient developed systemic edema leading to a diagnosis of pancreatic exocrine insufficiency after pancreaticoduodenectomy. Thus, pancreatic exocrine insufficiency should be considered in patients with edema after pancreaticoduodenectomy.

Author(s): Kensuke Minami, Ayako Kumabe, Yuka Sagara, Tsuneaki Kenzaka

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