Post-operative Complication after Pancreaticoduodenectomy -Identification of a High Risk Group for Cholangitis and its Management-

Hidefumi Ishida, Masahiro Yamamoto, Osamu Ohashi, Hidetoshi Fujiwara, Hirohiko Onoyama, Yoshikazu Kuroda, Setsu Sakamoto¹⁾, Katsuhito Yamasaki¹⁾, Michio Kono¹⁾, Mieko Matsui²⁾

First Department of Surgery, Department of Radiology¹⁾, Kobe University, School of Medicine
²⁾Department of Radiology Miki City Hospital

Long term outcome in 35 patients after pancreaticoduodenectomy (PD) was studied from the viewpoints of cholangitis and social rehabilitation, by means of serum markers, image findings and clinical symptoms. Cholangitis was observed postoperatively in 5 patients (14.3%), all of whom had undergone the PD-II procedure; the causes of postoperative cholangitis appeared to be bile stasis at the hepatohilar region or in the manipulated jejunal loop. In the patients who developed cholangitis, serum alkaline phosphatase (ALP) levels were elevated and unstable and bile stasis detected by biliary scintigraphy; clinical signs of cholangitis did not occur. To improve long term outcome after PD, it is important to identify patients with a high risk of cholangitis using these findings and to counsel them to modify their lifestyle. Four of 5 patients with cholangitis were able to achieve social rehabilitation to some extent and maintain an excellent quality of life (QOL) by avoiding recurrence of cholangitis.

Key words
pancreaticoduodenectomy, postoperative cholangitis, quality of life, biliary scintigraphy, serum alkaline phosphatase

Reprint requests
Hidefumi Ishida First Department of Surgery, Kobe University, School of Medicine
7-5-1 Kusunoki Cho, Chuo Ku, Kobe City, 650-0017 JAPAN

Accepted
April 22, 1998

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