Surgical treatment of pancreaticojejunal stenosis after pancreaticoduodenectomy: case report

TL;DR

This case report describes the surgical treatment of a rare late complication following a complex pancreatic surgery in an 18-year-old patient.

Contribution

The paper presents a novel case of late pancreaticojejunal stenosis managed with surgical revision and stent placement.

Findings

An 18-year-old female developed recurrent acute pancreatitis as a late complication after pancreaticoduodenectomy.

Surgical revision with dilation and stent placement resolved the stenosis without further complications.

Late complications of pancreaticoduodenectomy remain under-studied due to their low incidence and poor patient survival.

Abstract

Pancreaticoduodenectomy is established as the procedure of choice for malignant tumor pathologies of the head of the pancreas or ampulla, where the patient’s life prognosis is low. Complications after pancreaticoduodenectomy (e.g. pancreatic fistulas, hemorrhages, or intra-abdominal collection) are well described in the literature and are generally acute. However, there is still a small risk for late complications (e.g. pancreatitis, pancreatic insufficiency), and due to its low incidence, there has not been a consensus on the treatment. We present the case of an 18-year-old female with recurrent bouts of acute pancreatitis as a late complication of a pancreaticoduodenectomy plus pancreatojejunal anastomosis due to a pseudopapillary tumor of the pancreas. The complication was managed though surgical revision consisting of dilation and stent placement in the stenosis. The patient had an adequate postoperative evolution without further complications. Despite the advances in the surgical field, pancreaticoduodenectomy represents a highly complex surgery with high morbidity and mortality rates. The late complications of this surgery are under continuous study due to its low incidence associated with low patient survival.

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