Proximal migration of transanastomotic pancreatic stent following pancreaticoduodenectomy and pancreaticojejunostomy.
BACKGROUND
The use of catheters to stent the pancreaticojejunal anastomosis following pancreaticoduodenectomy is practiced by some surgeons. Their long-term effects in this setting, however, remain unknown.


METHODS
A 60-yr-old woman underwent a potentially curative pylorus preserving pancreaticoduodenectomy for Stage I ampullary carcinoma. Roux-en-Y pancreaticojejunostomy was constructed over a short stent. She presented 4 yr later with abdominal pain, steatorrhea, and weight loss. Computed tomography revealed a stent within the proximal pancreatic duct, with gross upstream ductal dilatation and parenchymal features of chronic pancreatitis.


RESULTS
Laparotomy revealed no disease recurrence. The stent, removed through a jejunotomy, was occluded. On-table pancreatogram demonstrated a 3-cm proximal duct stricture. Drainage was achieved with a lateral pancreaticojejunostomy (modified Puestow procedure). Recovery was uneventful, with clinical recovery of pancreatic exocrine function at 6 mo follow-up.


CONCLUSIONS
Proximal migration of transanastomotic pancreatic stent with subsequent development of chronic pancreatitis is a potential complication following pancreaticoduodenectomy. It can be managed effectively with stent removal and a lateral pancreaticojejunostomy.
Ammori
B J
BJ
Department of Surgery, Dewsbury and District General Hospital, UK. Basil@ammori.freeserve.co.uk
White
C M
CM
D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects; D002760:Cholangiopancreatography, Endoscopic Retrograde; D005260:Female; D005548:Foreign-Body Migration / Q000150:complications*; D006801:Humans; D008875:Middle Aged; D010183:Pancreatic Ducts / Q000000981:diagnostic imaging / Q000601:surgery; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D010193:Pancreaticojejunostomy / Q000009:adverse effects*; D010195:Pancreatitis / Q000000981:diagnostic imaging / Q000209:etiology; D015607:Stents / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed