# A Rare Case of Chronic Pancreatitis With Giant Branching Pancreatic Calculi and Large Pancreatic Pseudocysts: Diagnostic and Surgical Challenges

## TL;DR

This paper describes a rare case of chronic pancreatitis with unusually large pancreatic stones and pseudocysts, and the successful surgical treatment of the patient.

## Contribution

The novelty lies in the exceptionally large size of the pancreatic duct calculi, which are rarely reported in the literature.

## Key findings

- The patient had giant 'coral-like' pancreatic duct calculi measuring 30 × 35 mm and 32 × 12 mm.
- A modified Beger procedure with pancreaticojejunostomy was performed successfully with no major complications.
- The patient experienced significant clinical improvement post-surgery with only mild residual pain.

## Abstract

Pancreatic pseudocysts and ductal calculi are common complications of chronic pancreatitis (CP), with the management of pancreatic duct stones posing particular challenges due to complex ductal anatomy and a high risk of recurrence and procedural complications. We present the case of a female patient with long-standing CP who was admitted with severe, persistent abdominal pain refractory to nonsteroidal anti-inflammatory drug (NSAID) therapy and a 10-kg weight loss over the two months preceding hospitalization. Diagnostic imaging revealed pseudocysts in the head and body of the pancreas and giant “coral-like” calculi obstructing the main pancreatic duct. The patient underwent surgical treatment consisting of a Berne (modified Beger) procedure with pancreaticojejunostomy. The postoperative course was uneventful, with no significant complications. Treatment efficacy was evaluated using laboratory parameters, imaging findings, and clinical outcomes. At discharge, the patient reported only mild residual pain and was released in satisfactory condition. This case is notable for the presence of giant pancreatic duct calculi measuring 30 × 35 mm and 32 × 12 mm - dimensions that are exceptionally rare in the literature.