Percutaneous pancreatic-duct puncture with rendezvous technique can treat stenotic pancreaticojejunostomy.
Stenotic pancreatico-enteric anastomosis is one of the serious late complications after a pancreaticoduodenectomy. We report a case of stenotic pancreaticojejunostomy with a pancreatic juice fistula drained externally, which was treated using percutaneous procedures combined with a rendezvous method. A 77-year-old woman was referred to our hospital for an endoscopic treatment to remove a percutaneous drainage tube from a fluid collection due to pancreatic juice fistula. She had undergone pylorus-preserving pancreatoduodenectomy with Roux-en-Y reconstruction due to duodenal carcinoma of Vater's papilla 1 year before the referral to our hospital. Soon after the operation, she had developed a fluid collection adjacent to the anastomosis due to pancreatic juice fistulas and subsequently had undergone its percutaneous drainage. After admission, we tried to dilate the stenotic anastomosis with an endoscopic procedure from the anastomosed jejunal lumen, using an oblique-viewing endoscope. The endoscope reached a portion of the anastomosis, but did not allow us to visualize the entire anastomosis. We punctured the main pancreatic duct under ultrasonography and fluoroscopy, and advanced the needle into the anastomosed jejunum through the stenotic anastomosis. After putting a guidewire into the anastomosed jejunum through the needle, we introduced an oblique-viewing endoscope into the anastomosed jejunum and caught hold of the guidewire using grasping forceps. Maintaining tension on the guidewire with a slight pulling force, with some effort we were able to place a 5-Fr drainage catheter into the jejunum percutaneously and through the anastomosis via the main pancreatic duct. Three weeks after these procedures, we performed balloon dilation of the anastomosis. One week after balloon dilation, removed the percutaneous catheter.
Ota
Yuji
Y
Department of Gastroenterology, Hamamatsu Rosai Hospital, Shizuoka, Japan. jktpj232@yahoo.co.jp
Kikuyama
Masataka
M
Suzuki
Satsuki
S
Nakahodo
Jun
J
Koide
Shigeki
S
D000368:Aged; D003251:Constriction, Pathologic / Q000209:etiology / Q000601:surgery; D016145:Endoscopy, Digestive System / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010183:Pancreatic Ducts / Q000601:surgery*; D010193:Pancreaticojejunostomy / Q000009:adverse effects*; D010195:Pancreatitis / Q000209:etiology / Q000601:surgery*; D011677:Punctures / Q000379:methods*