Novel interventional treatment technique for intractable pancreatic fistula due to dehiscence of pancreatico-jejunal anastomosis following pancreaticoduodenectomy.

J Hepatobiliary Pancreat Surg

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.

Published: December 2008

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.

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00534-007-1257-yDOI Listing

Publication Analysis

Top Keywords

pancreatic fistula
28
pancreatic
9
novel interventional
8
dehiscence pancreatico-jejunal
8
pancreatico-jejunal anastomosis
8
external pancreatic
8
treatment strategy
8
conservative management
8
fistula
7
treatment
4

Similar Publications

Background: Pancreatic ductal adenocarcinoma (PDAC) typically occurs in an older patient population. Yet, early-onset pancreatic cancer (EOPC) has one of the fastest growing incidence rates. This study investigated the influence of age and tumor location on postoperative morbidity and mortality in a large, real-world dataset.

View Article and Find Full Text PDF

Clinical benefits of central pancreatectomy for a patient with pancreatic schwannoma and diabetes.

World J Surg Oncol

January 2025

Department of Hepatobiliary Surgery, Guangzhou Red Cross Hospital of Jinan University, Tongfu Roud 396, Guangzhou, 510220, Guangdong, China.

Schwannomas are tumors that originate from the glial cells of the nervous system and can occur on myelinated nerve fibers throughout the body, especially in the craniofacial region. However, pancreatic schwannomas are extremely rare. We report a case of a pancreatic schwannoma that was difficult to differentiate from other pancreatic tumors preoperatively.

View Article and Find Full Text PDF

Safety and efficacy of intraoperative radiation therapy using a low-energy X-ray source for resectable pancreatic cancer: an interim evaluation of an ongoing prospective phase II study.

Cancer Biol Med

January 2025

Department of Pancreatic Cancer, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China.

Objective: The role of intraoperative radiation therapy (IORT) in the management of resectable pancreatic cancer (RPC) remains unclear. To date, the application of IORT using a low-energy X-ray source has not been extensively investigated. Therefore, this study was conducted to evaluate the safety and efficacy of IORT using a 50 kV X-ray source in treating RPC.

View Article and Find Full Text PDF

Background/aim: To investigate risk factors of late acute remnant pancreatitis after pancreatoduodenectomy (PD), we propose the use of a suturing pitch calculated based on the diameter of the main pancreatic duct and the number of sutures used in the pancreatic duct-to-mucosa anastomosis. This study aimed to determine whether the suturing pitch can predict late acute pancreatitis following PD.

Patients And Methods: This study included 142 patients who underwent elective PD.

View Article and Find Full Text PDF

Want AI Summaries of new PubMed Abstracts delivered to your In-box?

Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!