Afferent limb percutaneous jejunostomy to treat pancreatic leak after pancreaticoduodenectomy: a case report

TL;DR

A 76-year-old man with a pancreatic leak after surgery was treated with a minimally invasive procedure that helped the leak heal.

Contribution

This case report introduces percutaneous jejunostomy of the afferent limb as a novel treatment for pancreatic leaks.

Findings

Percutaneous drainage of the afferent limb helped control the pancreatic leak.

Increased afferent limb pressures due to bowel dysmotility contributed to the leak.

The procedure promoted healing without the need for further surgery.

Abstract

Although the mortality after a pancreaticoduodenectomy (PD) is low, it increases with post-operative pancreatic leaks. In this case, a 76-year-old male with pancreatic head adenocarcinoma after successful PD developed a 6 cm fluid collection by the pancreaticojejunostomy (PJ). Interventional radiology proceeded with percutaneous drainage. Unfortunately, the drain color changed from purulent to bilious. A contrast study confirmed the drain’s position within the bowel lumen of the afferent limb. Although not the original intent, the patient progressed. Few cases describe percutaneous drainage of the blind end of the afferent limb. Here, the patient’s chronic bowel dysmotility contributed to increased afferent limb pressures, jeopardizing the PJ. Placement of the intra-luminal drain allowed for source control and decompression that promoted pancreatic leak healing. Hence, percutaneous jejunostomy of the blind jejunal end after PD can serve as a minimally invasive technique for pancreatic leaks secondary to increased pressures within the afferent limb.

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