Pancreas: chronic pancreatitis surgery: practice question

A General Surgery question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Surgery · Pancreas: chronic pancreatitis surgery

Sample item

A 41-year-old man with chronic alcoholic pancreatitis has intractable pain despite analgesics. CT and MRCP show a main pancreatic duct of 10 mm with multiple intraductal stones and no pancreatic head mass. Which operation is most appropriate?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Lateral pancreaticojejunostomy (Puestow or Partington-Rochelle)

A dilated main pancreatic duct (about 7 mm or more) in chronic pancreatitis is treated with longitudinal duct opening and side-to-side drainage to a Roux loop, relieving pain in the majority. If a head mass drives the disease, a Frey or Beger procedure or Whipple is chosen instead. Total pancreatectomy with islet autotransplantation is for small-duct disease.

Option by option

  • A. Total pancreatectomy only

    Total pancreatectomy causes brittle diabetes and is reserved for small-duct disease or failure of other options.

  • B. Lateral pancreaticojejunostomy (Puestow or Partington-Rochelle) (correct)

    Correct. Drainage of a dilated duct with stones is the operation of choice.

  • C. Coeliac plexus block repeated monthly

    Plexus blocks give only temporary relief and do not treat ductal hypertension.

  • D. Distal pancreatectomy

    Distal resection does not decompress a duct that is dilated throughout.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is B, Lateral pancreaticojejunostomy (Puestow or Partington-Rochelle). A dilated main pancreatic duct (about 7 mm or more) in chronic pancreatitis is treated with longitudinal duct opening and side-to-side drainage to a Roux loop, relieving pain in the majority.

Why is "Total pancreatectomy only" not the answer?

Total pancreatectomy causes brittle diabetes and is reserved for small-duct disease or failure of other options.

Why is "Coeliac plexus block repeated monthly" not the answer?

Plexus blocks give only temporary relief and do not treat ductal hypertension.

Why is "Distal pancreatectomy" not the answer?

Distal resection does not decompress a duct that is dilated throughout.

What concept does this question test?

It tests Pancreas: chronic pancreatitis surgery in General Surgery. If a head mass drives the disease, a Frey or Beger procedure or Whipple is chosen instead. Total pancreatectomy with islet autotransplantation is for small-duct disease.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Pancreas: chronic pancreatitis surgery?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.