A CASE SUCCESSFULLY TREATED BY ANASTOMOSIS BETWEEN PANCREATIC FISTULA AND THE JEJUNUM FOR PANCREATIC INTERNAL FISTULA AFTER NECROSECTOMY FOR INFECTED PANCREATIC NECROSIS

Masahiko MORIFUJI; Yoshiaki MURAKAMI; Yoshio TAKESUE; Masaru SASAKI; Shinnosuke UEGAMI; Taijiro SUEDA

doi:10.3919/jjsa.65.481

Masahiko MORIFUJI, Yoshiaki MURAKAMI, Yoshio TAKESUE, Masaru SASAKI, Shinnosuke UEGAMI, Taijiro SUEDA

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Keywords: necrosectomy

JOURNAL FREE ACCESS

2004 Volume 65 Issue 2 Pages 481-486

DOI https://doi.org/10.3919/jjsa.65.481

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Abstract

A 53-year-old man, whose pancreatic extra-fistula complicated after undergoing necrosectomy for lately infected pancreatic necrosis had gradually healed by conservative treatment, was admitted to the hospital again because of fever, severe back pain and cough 6 months after discharge. Abdominal computed tomography (CT) and endoscopic retrograde cholangiopancreatography (ERCP) showed severe stenosis of the main pancreatic duct and a rupture of the tail duct spreading to the mediastinum. It was suspected that high pressure in the pancreatic duct led to the rupture and caused the internal pancreatic fistula. CT also showed an obstruction of the portal vein and well-developed collateral vessels, which were successfully treated by side-to-end longitudinal pancreaticojejunostomy despite of the risk of massive bleeding. He was discharged from the hospital on the postoperative day 25, and the postoperative course was uneventful. We expected surgery would be difficult due to severe adhesions and bleeding from the collateral portal vein, but our approach was safe and useful in preserving the pancreatic function including pancreatic endocrine function.

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