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A case of delayed pancreatic fistula after covered self-expandable metallic stent deployment for pancreatic head cancer

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Abstract

A 69-year-old man was referred to our hospital with obstructive jaundice. A tumor with poor contrast enhancement was found in the pancreatic head, but there was no evidence of pancreatic atrophy, irregular stenosis, or dilation of the main pancreatic duct. He was diagnosed with borderline resectable pancreatic cancer with distal malignant biliary obstruction. After plastic stent placement, serum bilirubin levels improved, and chemotherapy was started. However, he developed cholangitis; thus, the plastic stent was replaced with a covered self-expandable metallic stent. He subsequently developed a delayed pancreatic fistula due to main pancreatic duct disruption. An endoscopic nasopancreatic duct drainage tube was placed to bridge the main pancreatic duct disruption after removing the covered self-expandable metallic stent. In addition, endoscopic ultrasound-guided transmural drainage was performed for the infected fluid collection caused by the pancreatic fistula, and the clinical symptoms quickly improved. This case presents the possibility of a delayed pancreatic fistula due to self-expandable metallic stent deployment. The need for considering such delayed complications when placing self-expanding metallic stents is highlighted.

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatobiliary and Pancreatic Diseases, Department of Internal Medicine, Hyogo Medical University, 1-1 Mukogawa-Cho, Nishinomiya, 663-8501, Japan

    Shogo Ota, Hideyuki Shiomi, Ryota Nakano, Takashi Nishimura, Hirayuki Enomoto & Hiroko Iijima

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  1. Shogo Ota
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  2. Hideyuki Shiomi
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  3. Ryota Nakano
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  4. Takashi Nishimura
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  5. Hirayuki Enomoto
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  6. Hiroko Iijima
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Correspondence to Hideyuki Shiomi.

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All the procedures followed in this study have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Ota, S., Shiomi, H., Nakano, R. et al. A case of delayed pancreatic fistula after covered self-expandable metallic stent deployment for pancreatic head cancer. Clin J Gastroenterol 16, 303–309 (2023). https://doi.org/10.1007/s12328-023-01759-0

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  • DOI: https://doi.org/10.1007/s12328-023-01759-0

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