Dubai:A 64 year old female resident of UAE from Algeria, Dr Lhamlah Nouacer consulted at Zulekha Hospital Dubai for severe upper abdominal and back pain for two months and deep severe jaundice for which she had also undergone an endoscopic stent placement in her home country. After the initial investigation with Dr. Abdelmajeed Mahmoud, Specialist Gastroenterology, Hepatology and GI endoscopy she was seen by Dr. Sivaprakash Rathanaswamy, Specialist Surgical Oncologist. When the family visited the hospital they consulted to check whether the hospital carries out the Whipple procedure. Dr. Sivaprakash assured the patient’s family that the procedure could be done, however further reviewed reports of the patient’s medical history to investigate.

According to the medical history of the patient, she had a severe case of jaundice with obstruction for which a stent was also put in place as the temporary solution three weeks ago. As part of the investigations Dr. Nouacer underwent a CT scan and faced few complications due to high creatinine levels and a single kidney. Being a survivor of uterine cancer since 1991, she had also undergone a major surgery in Germany with radiation that had led to gross swelling on her left leg. She was also diabetic and hypertensive for more than 20 years.

After reviewing endoscopic biopsy slides in Dubai, she was diagnosed periampullary carcinoma (common bile duct and pancreatic head cancer) with obstructive jaundice, status post stenting. The Whipple procedure was the best suitable treatment for this condition. After assuring Dr. Nouacer of a safe experience, the team carried out the surgery at Zulekha Hospital Dubai. The procedure is quite a morbid surgery and involved the removal of a part of the pancreas, bile duct, small bowel and part of the stomach followed by the reconstruction procedure.

The procedure took six hours and she was kept in the ICU overnight to avoid any complications due this being a high-risk procedure. By the fifth day, she started fully with orals and by the seventh day she went home without any tubes. The average recovery time in high volume centers as per literature is around eight to eleven days.
The doctor added, “The procedure was successful and the patient also tolerated the procedure well and the pathology was also normal. We are glad she started walking on the very first day itself with such a good recovery considering the complexity of the procedure she underwent. It is very satisfying for us as healthcare professionals as we are able help cancer patients on their journey to recovery. Let’s take a minute to commend the patient and her “I will survive” attitude. Even after being hit with diagnosis of conditions she may have never heard of, she got back up with the mental strength to go through it all and still came out a with a success story to tell.”

After healing, Dr. Nouacer started her chemo therapy as well. When asked about the future side effects such patients can have, the doctor adds, "Some patients with this issue can have delayed gastric emptying but she recovered immediately, apart from vomiting the first two days. The Whipple procedure is considered to be a very rare and complicated procedure with 20%-30% morbidity rate including pancreatic leaks and 5% mortality rate even in high volume centers. Not all hospitals perform the procedure due to its high complexity of the procedure and more demanding technical skills and postoperative care of the team”.
Dr. Nouacer shared her feedback saying, “I was confident that the doctor knew what he had to do to give me a permanent solution. I think that we can all learn a thing or two from this experience, that life may not always throw the best stuff at you but at the end of the day true strength lies in your heart and mind to see past the pain and pursue after the light at the end of the tunnel. Thank you.”