Fibrin glue injection method for complex fistula after laparoscopic distal pancreatectomy: a case report

Abstract

Background: Pancreatic fistula is the most problematic complication in pancreatectomy. Although drainage can be used to relieve this complication, pancreatic surgeons often encounter refractory pancreatic fistula. Fibrin glue injection, with the use of a twofold diluted solution B and a double-lumen tube, was found effective in treating this complicated pancreatic fistula.

Case presentation: We report the case of a 64-year-old Japanese man who underwent laparoscopic distal pancreatectomy for pancreatic tail cancer. After initial drainage of the pancreatic fistula diagnosed 4 days postoperatively, on day 134, refractory pancreatic fistula was observed using contrast-enhanced computed tomography. We used fibrin glue injection, with a twofold diluted solution containing thrombin and calcium chloride and a double-lumen tube, for treating the refractory fistula; the fluid drainage was almost stopped with no fever or abdominal pain. No recurrence of pancreatic cancer has been observed since the procedure.

Conclusions: Fibrin glue injection was effective for complicated pancreatic fistula after distal pancreatectomy. Using a twofold diluted solution B containing thrombin and calcium chloride and a double-lumen tube makes possible the thorough injection of fibrin glue.

Keywords: Distal pancreatectomy; Fibrin glue injection; Pancreatic fistula.

Fig. 1

Preoperative contrast-enhanced computed tomography scan. The yellow arrow indicates a pancreatic cancer site

Fig. 2

a Contrast-enhanced computed tomography examination on day 7 after surgery. The yellow, red, and blue arrows indicate the drain, stapler of pancreatic stump, and abscess formation of the pancreatic fistula, respectively. b Contrast-enhanced computed tomography examination on day 7 after surgery. The yellow and blue arrows indicate the drain and abscess formation of the pancreatic fistula, respectively

Fig. 3

A percutaneous drainage tube was inserted on day 7 after surgery (blue arrow)

Fig. 4

The abscess cavity was visualized by imaging from the drain on day 36 after surgery

Fig. 5

Contrast-enhanced computed tomography examination on day 134 after surgery. The yellow and blue arrows indicate the drain and the abscess cavity, respectively

Fig. 6

Drain imaging on day 134 after surgery. The contrast agent flows into the stomach from the red arrow portion. The black arrow indicates the line of the gastric wall