title: Associating pancreaticostomy and biliary-irrigation for staged pancreaticoduodenectomy approach to pancreatic intraductal papillary mucinous neoplasm with recurrent cholangitis and severe jaundice: A case report.
abstract: METHODS
  A 63-year-old man was hospitalized with history of abdominal pain since more than 1 year, and that of fever with chills since 2 weeks.
  
  
  METHODS
  Based on the laboratory investigations and radiologic findings, a preliminary diagnosis of pancreatic intraductal papillary mucinous neoplasm (IPMN) with recurrent cholangitis and severe jaundice was made.
  
  
  METHODS
  An initial attempt at endoscopic and image-guided drainage proved unsuccessful. Due to cholangitis, liver dysfunction, and hypoalbuminemia, the patient was deemed to be medically unfit for radical surgery. Therefore we considered a novel strategy of associating pancreaticostomy and biliary-irrigation for staged pancreaticoduodenectomy (APBSP). In the first stage, biliary tract double irrigation (endoscopic nasobiliary drainage and T-tube) in combination with pancreaticostomy was performed, which alleviated the symptoms and helped improve the general condition of the patient. In the second stage, radical pancreaticoduodenectomy was performed.
  
  
  RESULTS
  Over a follow-up period of 23 months, no recurrence occurred.
  
  
  CONCLUSIONS
  In this report, we present a previously unreported treatment strategy for pancreatic IPMN with recurrent cholangitis and jaundice. The innovative treatment approach may help advance the understanding and management of this condition.
authors.affiliation: Department of Hepatobiliary and Pancreatic Surgery, the Second Affiliated Hospital of Nanchang University Jiangxi Provincial Center for Hepatobiliary Disease, Nanchang, China.
authors.forename: Chao
authors.initials: C
authors.lastname: Dai
authors.forename: Siyuan
authors.initials: S
authors.lastname: Lou
authors.forename: Fan
authors.initials: F
authors.lastname: Zhou
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000150:complications / Q000601:surgery*; D021441:Carcinoma, Pancreatic Ductal / Q000150:complications / Q000601:surgery*; D002291:Carcinoma, Papillary / Q000150:complications / Q000601:surgery*; D002761:Cholangitis / Q000150:complications; D004322:Drainage; D006801:Humans; D007565:Jaundice / Q000150:complications; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000150:complications / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D012008:Recurrence; D007507:Therapeutic Irrigation