A 55-year-old man was admitted with pancreatitis evolving over 4months. This was associated with a weight loss of six kg. He had previous history of pancreatoduodenectomy around 8 years back forperiampullary tumor. The continuity of the digestive and pancreatic(Wirsung duct) ducts was re-established by the formation of an end-to-side pancreatico-jejunal anastomosis, as well as hepato-jejunal and gastro-jejunal anastomoses. The postoperative period was uneventful; following the surgery the patient was on regular follow up. He was asymptomatic until he developed acute onset abdominal pain 4months back. There was no history of alcohol consumption or regular consumption of medication. He suffered from recurrent attacks ofpancreatitis required two hospital admissions in last 4 months. He was evaluated using blood tests (full blood count, urea and electrolytes, liver function tests, triglycerides, carcinoembryonic antigen [CEA],and carbohydrate antigen ([CA] 19.9), C reactive protein) were within normal limits. No pancreatic necrosis was seen on computed tomography (CT) scan (Figure 1); however, a 7 mm dilatation of the pancreatic (Wirsung duct) duct, without parenchymal atrophy suggestive of chronic pancreatitis on MRCP. Imaging findings weresug gestive of an anastomotic stenosis. PET CT scan was negative for local or metastatic recurrence. A surgical intervention was carried out to treat the obstruction. Lesser sac entered from side of gastro-jej unostomy. Anterior surface of pancreas body exposed andpancreatic duct identified using needle aspiration technique. Pancreatic duct was opened for a length of 5 cm. Pancreas body andposterior wall of stomach were in close apposition, sopancreatojejunostomy was not taken down. Pancreatic ductal drainage achieved by a side-to-side anastomosis pancreato -gastrostomy.

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