A Case of Pancreatic Fistula Treated with Transpancreatic Stenting after Operation for Damage to the Head of the Pancreas

Satoshi Yodonawa, Isao Ogawa, Yukinobu Goto, Hiromichi Ito and Tatsuo Asagoe

Department Surgery, Ibaraki Seinan Medical Center Hospital

A 54-year-old man suffering abdominal injuries in a traffic accident underwent emergency laparotomy due to shock following massive intraperitoneal hemorrhage. During surgery, we discovered damage at the head of the pancreas, but due to the potential hazard of pancreatic resection, we only controlled bleeding and drained pancreatic fluid. After the operation, his general condition was improved, but pancreatic fluid continued leaking. We diagnosed this as main pancreatic duct injury using endoscopic retrograde pancreatography (ERP). We percutaneously filled the fistula with fibrin glue to stop leakage because secondary surgery (pancreatoduodenectomy) was considered difficult. The fistula was closed without pancreatitis appearing, and he left hospital afterwards. He was hospitalized two months later for pancreatitis with a pancreatic pseudocyst 4 cm in diameter. After percutaneous drainage, we attempted endoscopic transpapillary stenting. ERP showed that the proximal main pancreatic duct was connected by a pancreatic pseudocyst, so we inserted a stent from the main pancreatic duct to the pseudocyst. Pancreatic fluid leakage gradually decreased thereafter, although the stent came off naturally one week later. Six months later, pancreatic fluid leakage ceased completely, so the percutaneous drainage tube was removed. The patient remains in good condition without evidence of pancreatitis or pancreatic pseudocyst.

Key words
damage to the head of the pancreas, pancreatic fistula, transpancreatic stenting

Reprint requests
Satoshi Yodonawa Department of Surgery, Ibaraki Seinan Medical Center Hospital
2190 Sakai-machi, Sashima-gun, 306-0433 JAPAN

Accepted
July 26, 2006

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