Presented here is a case report of a 56 years old male patient with chronic pancreatitis in which a dramatic improvement in symptoms and objective findings were noted after endoscopic elimination of protein plugs. In September, 1979, he had an acute onset of pancreatitis followed by pseudocyst formation and the following combined operations were performed: resection of the pseudocyst, resection of the body and tail of the pancreas along with the spleen, partial resection of the stomach and the transverse colon, and gastroenterostomy according to Billroth I method. He had been followed up at out-patient clinic for chronic pancreatitis and diabetes until January 14,1979 when he was hospitalized for anorexia, loss of weight, pretibial edema, and upper-abdominal pain. The patient's condition was characterized by emaciation (height 152 cm, weight 37 kg), anemia (Hb 7.9g/dl), hypoproteinemia (serum protein 4.2 g/dl) , and hypolipidemia (total cholesterol 73 mg/dl). Abdominal ultrasound, abdominal CT and ERCP revealed stones in the pancreatic duct. Symptoms and objective findings were only partially improved by medical regimens. Subsequently we performed endoscopic cannulation of the pancreatic duct for elimination of pancreatic stones. Successful elimination of large numbers of protein plugs resulted in dramatic improvement of symptoms and objective findings. This procedure proved to add a new important tool in the treatment of chronic pancreatitis.
