Whipple’s following Puestow’s procedure: A challenging surgical scenario—case report with literature review

Chronic pancreatitis is an established risk factor for pancreatic ductal adenocarcinoma and poses significant diagnostic challenges because its clinical and radiologic features can closely mimic pancreatic malignancy. We report the case of a 42-year-old man with long-standing chronic calcific pancreatitis who developed pancreatic ductal adenocarcinoma involving the uncinate process after a prior lateral pancreaticojejunostomy (Puestow’s procedure). The patient subsequently underwent pancreaticoduodenectomy (Whipple procedure) with an initially uneventful postoperative course. However, a positron emission tomography–computed tomography performed 1 year later revealed a metabolically active aortocaval lesion, raising the suspicion of nodal recurrence. This case underscores the importance of maintaining a high index of suspicion, obtaining timely cross-sectional imaging, and ensuring meticulous long-term postoperative surveillance in patients with chronic pancreatitis, particularly those who have previously undergone pancreatic drainage procedures.