Case reportLate Pancreaticojejunostomy Stent Migration and Hepatic Abscess after Whipple Procedure
Introduction
The complexity of pancreaticoduodenectomy (PD) relates in part to the creation of 3 separate anastomoses required to reconstruct the continuity and drainage of the remaining pancreas, biliary tree, and upper gastrointestinal tract. Although associated operative mortality rates have diminished significantly over the last 20 years, complication rates continue to range as high as 50%,1 and they are often related to problems with one of the anastomoses, most often the pancreaticojejunostomy. Various techniques have been used to facilitate anastomosis of the remaining pancreas to the gastrointestinal tract and to attempt to diminish the chance for leakage with its resulting morbidity. Stenting of the pancreaticojejunostomy is one option. A previously unreported complication of stenting of a pancreaticojejunostomy is described: migration of the stent into the liver and abscess formation that occurred 4 years postoperatively. The efficacy of stenting, as well as its associated complications, are reviewed.
Section snippets
Case History
A 61-year-old woman presented with obstructive jaundice and was found to have a pancreatic mass. A temporary silastic stent was placed endoscopically to decompress the obstructed biliary tree. During exploratory laparotomy and PD, the endoscopically placed biliary stent was removed and reconstruction was carried out using a surgically placed internal stent across the pancreaticojejunostomy (Fig. 1). The postoperative course was complicated by delayed gastric emptying, which resolved.
Pathologic
Discussion
Despite reductions in operative mortality rates for PD over the last few decades, the rate of significant complications remains high and is often related to the creation of the pancreaticojejunostomy.2, 3 Leakage of pancreatic juice with its digestive enzymes can cause autolysis of normal tissues and lead to further disruption of healing anastomoses and surgical wounds. Pancreatic fistulas have been reported in 8% to 29% of patients and can lead to abscess, sepsis, bleeding, additional
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