title: Novel interventional treatment technique for intractable pancreatic fistula due to dehiscence of pancreatico-jejunal anastomosis following pancreaticoduodenectomy.
abstract: Despite recent technological advances in the treatment of hepatobiliary pancreatic disease, intractable external pancreatic fistula is still a major critical complication after pancreaticoduodenectomy, and the treatment strategy is not well defined. We report here a case that was successfully treated by our novel interventional internal drainage technique. A 62-year-old woman underwent pylorus-preserving pancreaticoduodenectomy for carcinoma of the papilla of Vater, with reconstruction by a modified Child's procedure. One year later, she was readmitted to our hospital because of external pancreatic fistula. Both computed tomography and fistulography demonstrated a pancreatic fistula derived from dehiscence of the pancreatico-jejunal anastomosis. The pancreatic fistula persisted for 1 week with conservative management. Therefore, we performed repeated fistulography and cannulation, using two comparatively stiff guidewires introduced into the main pancreatic duct and stenotic anastomosed jejunal lumen, respectively, and we placed an endoprosthesis, using bilateral guidewires to connect the two lumens. Consequently, the pancreatic fistula was successfully closed within a few days. Our novel technique is simple, rapid, and not costly. Therefore, it should be considered an effective treatment strategy for persistent pancreatic fistula following pancreaticoduodenectomy that fails to respond to initial conservative management and an endoscopic approach. Also, this technique is applicable to other intractable fistulous situations.
authors.affiliation: Division of Digestive Surgery, Department of Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kawaramachi-hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan.
authors.forename: Shuhei
authors.initials: S
authors.lastname: Komatsu
authors.forename: Teruhisa
authors.initials: T
authors.lastname: Sonoyama
authors.forename: Toshiya
authors.initials: T
authors.lastname: Ochiai
authors.forename: Daisuke
authors.initials: D
authors.lastname: Ichikawa
authors.forename: Hisashi
authors.initials: H
authors.lastname: Ikoma
authors.forename: Hiroko
authors.initials: H
authors.lastname: Okamura
authors.forename: Hisakazu
authors.initials: H
authors.lastname: Yamagishi
authors.forename: Eigo
authors.initials: E
authors.lastname: Otsuji
mesh_terms: D014670:Ampulla of Vater; D000714:Anastomosis, Surgical; D002404:Catheterization / Q000379:methods; D003138:Common Bile Duct Neoplasms / Q000601:surgery; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D008875:Middle Aged; D010185:Pancreatic Fistula / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D019736:Prostheses and Implants; D019919:Prosthesis Implantation; D015641:Radiography, Interventional