DOI: https://doi.org/10.36347/sasjm.2026.v12i09.019

Pages: 930-931

Background: Pancreatic lipomatosis is traditionally viewed as an age-related or metabolic incidental finding. However, in the context of chronic pancreatitis (CP), it acts as a surrogate marker for extensive parenchymal atrophy, fibrosis, and loss of structural compliance. Case Presentation: We report the case of a 70-year-old female patient with long-standing type 2 diabetes and advanced chronic calcific pancreatitis. Imaging revealed total fatty replacement of the pancreatic parenchyma with severe obstructive macro-lithiasis (22 mm) and Wirsung duct dilatation (13 mm). Following an endoscopic retrograde cholangiopancreatography (ERCP) procedure for lithiasis extraction, the patient developed a symptomatic duodenal perforation. Conclusion: The presence of advanced pancreatic lipomatosis significantly alters the mechanical properties of the pancreatic-duodenal unit, elevating the risk of iatrogenic injury. This case underscores the necessity of a multidisciplinary surgical evaluation over repeated endoscopic interventions in patients with end-stage lipomatous atrophy.