Endoscopic pancreatic stent insertion for treatment of pseudocyst after distal pancreatectomy

Abstract

Pancreatic fistula and pseudocyst are common complications of pancreatic resection. 1 Ridgeway MG Stabile B. Surgical management and treatment of pancreatic fistulas. Surg Clin North Am. 1996; 76: 1159-1173 Abstract Full Text Full Text PDF PubMed Scopus (71) Google Scholar , 2 Bassi C Falconi M Pederzoli P Pancreatic fistula. in: 3rd ed. Surgical diseases of the pancreas. : Williams & Wilkins, Baltimore1998: 827-834 Google Scholar Such complications prolong hospitalization and may lead to abscess formation, sepsis, and hemorrhage. 1 Ridgeway MG Stabile B. Surgical management and treatment of pancreatic fistulas. Surg Clin North Am. 1996; 76: 1159-1173 Abstract Full Text Full Text PDF PubMed Scopus (71) Google Scholar , 2 Bassi C Falconi M Pederzoli P Pancreatic fistula. in: 3rd ed. Surgical diseases of the pancreas. : Williams & Wilkins, Baltimore1998: 827-834 Google Scholar Most fistulas and pseudocysts resolve spontaneously, albeit over lengthy periods, with conservative treatment including pancreatic rest (no oral intake with total parenteral nutrition or octreotide administration) and adequate drainage (drains placed during the initial operation or postoperatively via the percutaneous approach). 1 Ridgeway MG Stabile B. Surgical management and treatment of pancreatic fistulas. Surg Clin North Am. 1996; 76: 1159-1173 Abstract Full Text Full Text PDF PubMed Scopus (71) Google Scholar , 2 Bassi C Falconi M Pederzoli P Pancreatic fistula. in: 3rd ed. Surgical diseases of the pancreas. : Williams & Wilkins, Baltimore1998: 827-834 Google Scholar , 3 Pederzoli P Bassi C Falconi M Albrigo R Vantini I Micciolo R. Conservative treatment of external pancreatic fistulas with parenteral nutrition alone or in combination with continuous intravenous infusion of somatostatin, glucagon or calcitonin. Surg Gynecol Obstet. 1986; 163: 428-432 PubMed Google Scholar , 4 Prinz RA Pickleman J Hoffman JP. Treatment of pancreatic cutaneous fistulas with a somatostatin analog. Am J Surg. 1988; 155: 36-42 Abstract Full Text PDF PubMed Scopus (139) Google Scholar For pancreatic fistulas and pseudocysts refractory to conservative treatment, surgical intervention is indicated but is often technically difficult and associated with a high morbidity rate (13%). 5 Lipsett PA Cameron JL. Internal pancreatic fistula. Am J Surg. 1992; 163: 216-220 Abstract Full Text PDF PubMed Scopus (121) Google Scholar Only a few reports have described endoscopic pancreatic stent placement for treatment of pancreatic duct leakage after pancreatic resection. 6 Saeed ZA Ramirez FC Hepps KS. Endoscopic stent placement for internal and external pancreatic fistulas. Gastroenterology. 1993; 105: 1213-1217 PubMed Google Scholar , 7 Sarzen CD. Endoscopic management of pancreatic duct leak complicated by retrogastric abscess. Am J Gastroenterol. 1995; 90: 2039-2041 PubMed Google Scholar Herein is described a case in which endoscopic transpapillary placement of a pancreatic stent was effective treatment for a pancreatic pseudocyst that developed after distal pancreatectomy.