Two-staged hepato-pancreatoduodenectomy and interventional pancreaticojejunostomy

Hepatogastroenterology. 2005 Nov-Dec;52(66):1886-8.

Abstract

Two-staged pancreatoduodenectomy, including exteriorization of the pancreatic juice and second-look pancreaticojejunostomy, has been recommended for high-risk patients to avoid pancreatic leakage, which often causes intra-abdominal hemorrhage. We present a new technique of interventional pancreaticojejunostomy under both fluoroscopy and endoscopy without second-look laparotomy. A 77-year-old woman with local recurrence and liver metastasis from colon cancer underwent hepato-pancreatoduodenectomy with the external drainage of pancreatic juice via the pancreatic duct tube without pancreaticojejunostomy. Two months later, the jejunum was punctured with the insertion of a 5-F needle-knife into the pancreatic fistula during endoscopic observation of jejunal lumen, followed by the insertion of two 0.35-inch guidewires into the jejunum and the pancreatic fistula. Finally, a 10-Fr stenting tube was placed between the jejunum and the pancreatic fistula. No complications developed.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Colorectal Neoplasms / pathology*
  • Colorectal Neoplasms / surgery
  • Combined Modality Therapy
  • Endoscopy, Digestive System / methods
  • Female
  • Follow-Up Studies
  • Humans
  • Liver Neoplasms / pathology
  • Liver Neoplasms / secondary*
  • Liver Neoplasms / surgery*
  • Neoplasm Staging
  • Neoplasms, Multiple Primary / pathology
  • Neoplasms, Multiple Primary / surgery*
  • Pancreatic Fistula / etiology
  • Pancreatic Fistula / therapy
  • Pancreaticoduodenectomy / adverse effects
  • Pancreaticoduodenectomy / methods*
  • Pancreaticojejunostomy / adverse effects
  • Pancreaticojejunostomy / methods*
  • Risk Assessment
  • Stents
  • Treatment Outcome