Severe acute pancreatitis 5 years after pancreaticoduodenectomy: A case report

Abstract

Introduction: Acute pancreatitis is a known complication of pancreaticoduodenectomy (PD). However, no reports in the literature describe a late delayed severe acute pancreatitis. We report a case of acute pancreatitis 5 years after PD in a patient who needed intensive care for his complication.

Presentation of case: A 64-years-old man presented with upper abdominal pain and reported a history of PD 5 years prior to presentation. Contrast-enhanced computed tomography revealed an edematous pancreatic remnant with inflammation of the surrounding tissue, and he was diagnosed with acute pancreatitis. His condition worsened, and he was transferred to our hospital the following day. He was admitted to the intensive care unit to manage respiratory and circulatory insufficiency. Although his condition improved, an abdominal abscess was identified, and necrosectomy was performed on day 43 of hospitalizaiton. We carefully removed as much necrotic tissue as was possible without injury to the pancreaticojejunal anastomosis and the ascending colon. Inflammation gradually subsided, and he was discharged on day 111 of hospitalization. The last drain was removed in day 133 of admission to our hospital. Pancreatitis and abdominal abscess have not recurred until the time of writing this paper.

Discussion: Delayed severe acute pancreatitis is rare. Necrosectomy can treat an abdominal abscess; however it is important to avoid injury to other organs.

Conclusion: Clinicians should be aware that severe acute pancreatitis can occur after PD.

Keywords: Acute pancreatitis; Case report; Necrosectomy; Pancreaticoduodenectomy.

Fig. 1

Contrast-enhanced CT scan showing spread of inflammation throughout the abdomen. (a) Axial view, (b) Coronal view.

Fig. 2

Abdominal CT scan obtained on (a)day16, (b)day23, and (c)day42 of hospitalization showing gradual transformation of ascites into an abdominal abscess (arrow).

Fig. 3

(a)Intraoperative findings showing removal of the abscess located anterior to the site of the pancreaticojejunostomy (arrow) and right paracolic gutter. (b)Image showing the removed necrotic tissue.