Late failure of Frey procedure due to gastro-jejunal fistula formation.
BACKGROUND
Local resection of the pancreatic head with longitudinal pancreaticojejunostomy (or Frey procedure) generally results in excellent pain relief in chronic pancreatitis. We report a patient with chronic pancreatitis who experienced pain recurrence after an uneventful longitudinal pancreaticojejunostomy.


METHODS
This is a single case study of a 58-year-old female with chronic pancreatitis undergoing longitudinal pancreaticojejunostomy for pain relief. Fifteen months after the surgery, the patient experienced pain recurrence. Radiologic evaluation followed by surgical exploration revealed a gastroenteric fistula to the Roux-limb, with obliteration of the anastomosis. After repair of the fistula and re-excavation of the pancreatic head, a two-layer longitudinal pancreaticojejunostomy was reconstructed from the same Roux-limb. An omental flap was interposed between the Roux limb and the repaired stomach. At 6-month follow-up, the patient was pain free and asymptomatic.


CONCLUSIONS
Late failure of the Frey procedure due to a gastroenteric fistula to the Roux-limb of jejunum has not been previously reported. This finding may explain one of the causes of longitudinal pancreaticojejunostomy late failure.
Rabiee
Atoosa
A
Department of Surgery, Johns Hopkins Bayview Medical Center, Baltimore, MD 21224, USA. arabiee1@jhmi.edu
Moreman
Kevin
K
Nikoomanesh
Parviz
P
Andersen
Dana K
DK
D005260:Female; D006801:Humans; D007412:Intestinal Fistula / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D008875:Middle Aged; D010146:Pain / Q000209:etiology; D010193:Pancreaticojejunostomy / Q000009:adverse effects / Q000379:methods*; D050500:Pancreatitis, Chronic / Q000601:surgery; D011183:Postoperative Complications / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D012008:Recurrence; D013997:Time Factors