Exocrine Pancreatic Insufficiency: Postoperative Complication Emerging Decades after Surgery?

Exocrine pancreatic insufficiency (EPI) arises from a deficiency in pancreatic enzymes, leading to malabsorption and varied symptoms such as gastrointestinal discomfort, weight loss and steatorrhea. Though EPI commonly follows chronic pancreatitis or pancreatic surgery, its delayed onset is rarely discussed. We report a unique case of EPI manifesting 29 years after pancreaticoduodenectomy. A 71-year-old female, who underwent pancreaticoduodenectomy for carcinoma in 1992, presented with fatigue, weight loss, edema, diarrhea and paresthesias. Physical examination revealed mucocutaneous pallor, ascites, lower limb edema and brittle hair. Laboratory results indicated anemia, hypoproteinemia, vitamin deficiencies and severe fecal elastase reduction. After excluding other possible etiologies such as malignancy, autoimmune and infectious, the diagnosis of EPI was established. Treatment included enzyme replacement, vitamin supplementation and diuretics, leading to symptom resolution and normalization of laboratory parameters over a 12-month period. This case underscores the prolonged latency of post-surgical EPI, presenting diagnostic challenges. Exocrine pancreatic insufficiency can severely impair nutrient absorption, causing significant morbidity. In our patient, timely enzyme supplementation and nutritional management reversed the symptoms and deficiencies. The 29-year delay in symptom onset is among the longest documented, emphasizing the need for long-term vigilance in post-pancreatic surgery patients.