Duodenal access loop for chronic calcific pancreatitis related gastric outlet obstruction: a novel surgical approach to facilitate future pancreatic endotherapy

Abstract Background Chronic calcific pancreatitis complicated by gastric outlet obstruction and fixed duodenal stricture presents a difficulttherapeutic challenge, particularly when endoscopic retrograde cholangiopancreatography (ERCP) is impossible because the ampulla cannot be reached. Conventional bypass procedures relieve obstruction but do not preserve future endoscopic access to the periampullary region. We describe a novelreconstructive approach designed to maintain the possibility of future pancreatic endotherapy. Case Presentation An 18-year-old woman with chroniccalcific pancreatitis presented with recurrent abdominal pain, postprandial vomiting, early satiety, and weight loss. Endoscopy demonstrated an impassableD1/D2 stricture, and repeated ERCP attempts failed because the ampulla was inaccessible. Computed tomography and magnetic resonancecholangiopancreatography revealed diffuse pancreatic calcifications, a 1.2 × 1.0 cm obstructing main pancreatic duct stone at the pancreatic neck, mildductal dilatation, and marked gastric dilatation. The patient underwent retrocolic gastrojejunostomy to relieve gastric outlet obstruction, followed by a sideto-side duodenojejunostomy between D2/D3 and the proximal jejunum to preserve potential future endoscopic access to the periampullary region. A distalside-to-side jejunojejunostomy was added to maintain intestinal continuity and minimize bile reflux. Results The postoperative course was uneventfulwithout anastomotic leak, hemorrhage, or infective complications. Oral intake was resumed gradually, and the patient was discharged in good condition. Attwo years of follow-up, she remained symptomatically well with satisfactory oral intake, good pain control, and no further episodes of gastric outletobstruction or requirement for pancreatic endotherapy. Conclusion This novel duodenal access loop reconstruction combines effective surgical relief ofgastric outlet obstruction with preservation of a potential future endoscopic route to the ampullary region. Although future cannulation through the accessloop was not required in this patient, the technique represents a pragmatic and potentially valuable surgical option for carefully selected patients withchronic pancreatitis and inaccessible periampullary anatomy. Further experience is required to validate its reproducibility and long-term utility.