Percutaneous Treatment using a T-tube or an Internal Drainage Tube is a Useful Method for Pancreaticocutaneous Fistula that may Occur following Pancreaticoduodenectomy. Report of Two Cases

Mayumi Kawamata, Haruki Kurosawa, Shigeharu Komatsu, Mitsutaka Sugita, Youhei Hamaguchi, Hidenobu Masui, Tadao Fukushima, Masatoshi Mogaki, Kaoru Nagahori and Hiroshi Shimada*

Department of Surgery, Yokosuka Kyosai Hospital
Department of Gastroenterological Surgery, Yokohama City University, Graduate School of Medicine*

We report two cases of refractory pancreaticocutaneous fistula, a critical complication that may occur after pancreaticoduodenectomy (PD), successfully treated by interventional internal drainage. Case 1: A 68-year-old man who underwent pylorus-preserving pancreaticoduodenectomy (PpPD) for bile-duct carcinoma began discharging pancreatic juice from the drain on postoperative day (POD) 5, but this halted and the fistula healed spontaneously. The patient was discharged on POD55. However, 3 days later, the fistula showed bleeding and he was readmitted. Abdominal CT and angiography showed bleeding from a pseudo aneurysm at the stump of the gastroduodenal artery, necessitating embolotherapy. Pancreatic juice then began to leak from the fistula. Drainage was continued, but leakage was not cured. On POD142, a T-tube was inserted into the elevated jejunum and the pancreatic duct for internal drainage. About 3 months later, the T-tube was removed. Case 2: A 74-year old woman underwent PpPD for bile duct carcinoma. Pancreatic juice started discharging from the drain, but halted and the fistula healed spontaneously. She was discharged on POD46. However, soon after that, the pancreaticocutaneous fistula wound showed exudation and she was readmitted. A drainage tube was inserted into the pancreatic duct from the fistula. On POD333, a lost-stent short tube was inserted into the elevated jejunum and pancreatic duct for internal drainage. The leakage of pancreatic juice stopped 6 days after this insertion. Percutaneous treatment using a T-tube or an internal drainage tube is useful for pancreaticocutaneous fistula following PD.

Key words
pancreaticocutaneous fistula, interventional internal drainage, pancreaticoduodenectomy

Reprint requests
Mayumi Kawamata Department of Surgery, Yokohama Citizen's Hospital
56 Okazawa-cho, Hodogaya-ku, Yokohama, 240-8855 JAPAN

Accepted
July 23, 2008

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