A Case of Iatrogenic Injury of the Duodenal Papilla Successfully Treated by T-tube Drainage and Subsequent Operation

Jun Nakamura, Takao Ohtsuka, Yoshihiko Kitajima, Yuji Nakafusa and Kohji Miyazaki

Department of Surgery, Saga University Faculty of Medicine

A 36-year-old man underwent distal gastrectomy with Billroth-II-type reconstruction at another hospital for pyloric stenosis secondary to a gastric ulcer. The serum bilirubin and amylase concentrations became elevated on postoperative day 1, and abdominal computed tomography showed dilatation of the intrahepatic bile duct, swelling of the pancreas, and the peripancreatic fluid collection. A diagnosis of obstructive jaundice and severe acute pancreatitis was made, and percutaneous transhepatic biliary drainage (PTBD) was performed. After PTBD, the patient was transferred to our hospital. The amylase concentration of the peripancreatic fluid drained percutaneously was 262,000 IU/L. Cholangiography and endoscopy suggested iatrogenic injury of the duodenal papilla by autosuture material. Fistulography showed a communication between the main pancreatic duct and the duodenal stump, and a T-tube was inserted through the pancreatic fistula into the pancreatic duct and the duodenum. About 3 months after insertion of the T-tube, fistulo-jejunostomy (Lahey & Lium method) and hepatico-jejunostomy were performed, and the T-tube was removed about 7 months later. The patient has been doing well to date.

Key words
iatrogenic injury of the duodenal papilla, pancreatic fistula, T-tube

Reprint requests
Jun Nakamura Department of Surgery, Saga University Faculty of Medicine
5-1-1 Nabeshima, Saga, 849-8501 JAPAN

Accepted
May 31, 2006

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