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Case Reports
. 2024 Jun 11;2024(6):rjae239.
doi: 10.1093/jscr/rjae239. eCollection 2024 Jun.

Surgical treatment of pancreaticojejunal stenosis after pancreaticoduodenectomy: case report

David Narvaez Salas  1 , Estefania Roldan-Vasquez  1 , Ricardo Negrete Ocampo  2 , Romina Ballagan Escobar  3 , Juan Roldan Crespo  2
Affiliations
Case Reports

Surgical treatment of pancreaticojejunal stenosis after pancreaticoduodenectomy: case report

David Narvaez Salas et al. J Surg Case Rep. .

Abstract

Pancreaticoduodenectomy is established as the procedure of choice for malignant tumor pathologies of the head of the pancreas or ampulla, where the patient's life prognosis is low. Complications after pancreaticoduodenectomy (e.g. pancreatic fistulas, hemorrhages, or intra-abdominal collection) are well described in the literature and are generally acute. However, there is still a small risk for late complications (e.g. pancreatitis, pancreatic insufficiency), and due to its low incidence, there has not been a consensus on the treatment. We present the case of an 18-year-old female with recurrent bouts of acute pancreatitis as a late complication of a pancreaticoduodenectomy plus pancreatojejunal anastomosis due to a pseudopapillary tumor of the pancreas. The complication was managed though surgical revision consisting of dilation and stent placement in the stenosis. The patient had an adequate postoperative evolution without further complications. Despite the advances in the surgical field, pancreaticoduodenectomy represents a highly complex surgery with high morbidity and mortality rates. The late complications of this surgery are under continuous study due to its low incidence associated with low patient survival.

Keywords: pancreatitis; pancreato-jejunostomy stenosis; pancreatoduodenectomy.

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Conflict of interest statement

None declared.

Figures

Figure 1
Figure 1
No inflammatory involvement of the body or pancreatic tail is observed; there is no alteration of the peripancreatic fat or collections at this level; visible wirsung canal measures 2.2 mm (red arrow).
Figure 2
Figure 2
(A) Thickening of the tail of the pancreas with hyperintensity in diffusion sequence (white arrow), anteroposterior diameter 30 mm, inflammatory changes in the body and neck of the pancreas, discreet postcontrast enhancement, and findings suggestive of recurrent interstitial edematous acute pancreatitis; (B) 3D reconstruction with evidence of narrowing of the pancreatojejunal anastomosis (blue arrow).
Figure 3
Figure 3
(A) Pancreato-jejunal anastomosis (white arrow); (B) enterotomy, mechanical dilation of the PJ anastomosis, and plasty (light blue arrow); (C) placement of plastic stent in PY anastomosis (blue arrow).
See this image and copyright information in PMC

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