title: Endoscopic naso-pancreatic drainage for the treatment of pancreatic fistula occurring after LDLT.
abstract: Pancreatic fistula is a quite rare complication in patients who undergo living donor liver transplantation (LDLT). However, in the cases that show pancreatic fistula, the limited volume of the graft and the resultant inadequate liver function may complicate the management of the fistula. As a result, the pancreatic fistula may result in the death of the patient. We present 2 cases in which endoscopic treatment was effective against pancreatic fistulas that developed after LDLT. In case 1, a 61-year-old woman underwent LDLT for primary biliary cirrhosis. Because of a portal venous thrombus caused by a splenorenal shunt, the patient underwent portal vein reconstruction, and a splenorenal shunt was ligated on postoperative day (POD) 7. The main pancreatic duct was injured during the manipulation to achieve hemostasis, thereby necessitating open drainage. However, discharge of pancreatic fluid continued even after POD 300. Endoscopic naso-pancreatic drainage (ENPD) was performed, and this procedure resulted in a remarkable decrease in drain output. The refractory pancreatic fistula healed on day 40 after ENPD. In case 2, a 58-year-old man underwent LDLT for cirrhosis caused by the hepatitis C virus. When the portal vein was exposed during thrombectomy, the pancreatic head was injured, which led to the formation of a pancreatic fistula. Conservative therapy was ineffective; therefore, ENPD was performed. The pancreatic fistula healed on day 38 after ENPD. The findings in these 2 cases show that endoscopic drainage of the main pancreatic duct is a less invasive and effective treatment for pancreatic fistulas that develop after LDLT.
authors.affiliation: Department of General Surgery, Graduate School of Medicine, Hokkaido University, N-15 W-7, Kita-ku, 060-8638 Sapporo, Japan.
authors.forename: Akihisa
authors.initials: A
authors.lastname: Nagatsu
authors.forename: Masahiko
authors.initials: M
authors.lastname: Taniguchi
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Shimamura
authors.forename: Tomomi
authors.initials: T
authors.lastname: Suzuki
authors.forename: Kenichiro
authors.initials: K
authors.lastname: Yamashita
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kawakami
authors.forename: Daisuke
authors.initials: D
authors.lastname: Abo
authors.forename: Toshiya
authors.initials: T
authors.lastname: Kamiyama
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Furukawa
authors.forename: Satoru
authors.initials: S
authors.lastname: Todo
mesh_terms: D004322:Drainage / Q000379:methods*; D004724:Endoscopy; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D010185:Pancreatic Fistula / Q000209:etiology* / Q000601:surgery*; D016896:Treatment Outcome