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Treatment of delayed pancreatic fistula associated with anastomosis breakdown after pancreaticoduodenectomy using percutaneous interventions

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Abstract

We here present a rare case of development of a postoperative pancreatic fistula and breakdown of the pancreaticojejunal anastomosis 8 months after pancreaticoduodenectomy. A 70-year-old man underwent pancreaticoduodenectomy for distal cholangiocarcinoma and initially recovered well. However, 8 months later, he developed abdominal pain and distention and was admitted to our institution with suspected pancreatitis. On the 17th day of hospitalization, he suddenly bled from the jejunal loop and a fluid collection was detected near the pancreaticojejunal anastomosis site. The fluid collection was drained percutaneously. Subsequent fistulography confirmed breakdown of the pancreaticojejunal anastomosis. Considering the patient's overall condition and the presence of postoperative adhesions, we decided to manage him conservatively. An additional drain tube was placed percutaneously from the site of the anastomotic breakdown into the lumen of the jejunum, along with the tube draining the fluid collection, creating a completely new fistula. This facilitated the flow of pancreatic fluid into the jejunum and was removed 192 days after placement. During a 6-month follow-up, there were no recurrences of pancreatitis or a pancreatic fistula. This case highlights the efficacy of percutaneous drainage and creation of an internal fistula as a management strategy for delayed pancreatic fistula and anastomotic breakdown following pancreaticoduodenectomy.

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Abbreviations

POPF:

Postoperative pancreatic fistula

PD:

Pancreaticoduodenectomy

PJA:

Pancreaticojejunal anastomosis

CT:

Computed tomography

US:

Ultrasonography

MPD:

Main pancreatic duct

POD:

Postoperative day

DBE-ERCP:

Double-balloon enteroscopy-endoscopic retrograde cholangiopancreatography

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Acknowledgements

The authors would like to thank Edanz (https://jp.edanz.com/ac) for editing a draft of this manuscript.

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Authors and Affiliations

  1. Department of Surgery, National Hospital Organization Hokkaido Medical Center, 1-1, Yamanote-5-7, Nishi-ku, Sapporo, 063-0005, Japan

    Reimi Suzuki, Yuji Konishi, Kai Makino, Yosuke Wakui, Kazuhiro Mino & Hideki Kawamura

  2. Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan

    Ryo Morita & Daisuke Abo

  3. Department of Gastroenterological Surgery I, Hokkaido University, Sapporo, Japan

    Tatsuhiko Kakisaka & Akinobu Taketomi

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  1. Reimi Suzuki
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  2. Yuji Konishi
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Correspondence to Reimi Suzuki.

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Suzuki, R., Konishi, Y., Makino, K. et al. Treatment of delayed pancreatic fistula associated with anastomosis breakdown after pancreaticoduodenectomy using percutaneous interventions. Clin J Gastroenterol 17, 356–362 (2024). https://doi.org/10.1007/s12328-023-01900-z

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  • DOI: https://doi.org/10.1007/s12328-023-01900-z

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