Chronic pancreatitis is a disease characterized by progressive inflammation and fibrosis of the exocrine pancreas. Surgical treatment is most often indicated for chronic pain. Classically, the operation of choice has been a longitudinal pancreaticojejunostomy (Puestow procedure). However, some patients have a chronic inflammatory mass in the pancreatic head, and for such patients simple duct decompression may not be adequate treatment. Because traditional pancreatic head resection (Whipple procedure) is associated with significant short-term and long-term morbidity, Frey and Beger have independently developed operations in which a near-total resection of the pancreatic head is performed in a manner which preserves the duodenum.

The patient is a 56 year old male with a history of chronic alcohol abuse who had undergone a prior longitudinal pancreaticojejunostomy in 1999. He did well for two years but then developed recurrent pain. In 2004 he developed jaundice and an ERCP showed a biliary stricture secondary to chronic pancreatitis. A CT scan demonstrated inflammatory enlargement in the head of his pancreas with calcifications and cystic areas. He was treated with an endoscopic biliary stent. This relieved his jaundice but his pain became more severe over the next few months. The patient underwent a duodenum-preserving pancreatic head resection (Beger procedure) which necessitated taking down his previous Puestow procedure. The patient's postoperative course was unremarkable and his pain is improving.