A Case of Intractable Pancreatic Fistula after Pancreatoduodenectomy, Successfully Cured by Fistulo-jejunostomy

Toshiaki Shiogama, Hiroshi Fukui, Yasutaka Tsurunaga, Akimasa Mizutani, Takayuki Asakawa, Toshiyasu Tanaka

Department of Surgery, Nagasaki Memorial Hospital

Several therapeutic efforts have been attempted to achieve closure of pancreatic fistula, none of which has been uniformly successful. We report a case of intractable pancreatic fistula occurring after pancreatoduodenectomy that was successfully cured by fistulo-jejunostomy. The patient was a 50-yearold man who underwent pancreatoduodenectomy for bile duct carcinoma. After removal of the stent tube inserted into the pancreatic duct, pancreatic juice started to discharge from the drain set on the pancreas and pancreatic fistula developed. In addition to conventional therapy for pancreatic fistula, somatostatin analogue was administered. This decreased fistula output but failed to achieve complete healing. The pancreatic fistula persisted with 150-200 ml/day of amylase-rich effluent. Fistulogram showed pancreatic duct but no flow of contrast material into the jejunum anastomosed with the pancreas at pancreatoduodenectomy. Therefore, conservative therapy was stopped and he underwent surgical treatment 50 days after occurrence of the fistula (75 days after pancreatoduodenectomy). At laparotomy, pancreatic fistulo-jejunostomy was performed. The postoperative course was good, and the patient was discharged 42 days after fistulo-jejunostomy. He was healthy at the last follow-up, one year and four months later.

Key words
pancreatic fistula, pancreatic fistulo-jejunostomy, somatostatin analogue

Reprint requests
Toshiaki Shiogama Department of Surgery, Nagasaki Memorial Hospital
1-11-54 Fukahoricho, Nagasaki, 851-03 JAPAN

Accepted
April 5, 1995

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