TWO CASES OF INTRACTABLE EXTERNAL PANCREATIC FISTULA FOLLOWING PANCREATICODUODENECTOMY SUCCESSFULLY CURED BY INTER VENTIONAL INTERNAL DRAINAGE

Abstract

External pancreatic fistula due to dehiscence of pancreatico-jejunal anastomosis is still critical complication after pancreatoduodenectomy (PD). This paper describes two cases of intractable external pancreatic fistula following PD that was treated by interventional inner drainage. In case 1. the patient underwent a hepatopancreatoduodenectomy (HPD) for a carcinoma of the gallbladder. Few days after the operation, anastomotic dehiscence became apparent and an external pancreatic fistula was developed. The fistula persisted for about four months after HPD and application of fistulo-jejunostomy was considered. Fistulography was performed and the main pancreatic duct was demonstrated under fluoroscopy. Cannulation into the main pancreatic duct and into the jejunal lumen on the opposite side was accomplished and a stest tube was placed to connect the both channel. The second patient underwent pylorus preserving PD (PpPD) for a carcinoma of the papilla of Vater but it also coursed pancreatico-jejunal anastomotic dehiscence and intractable external pancreatic fistula. The patient was administered a somatostatin analogue. It decreased fistula output but failed to achieve complete closure of the fistula. Cannulation into the pancreatic duct and jejunum was accomplished in the same way and a drainage tube was inserted into the pancreatic duct and placed through the jejunum via percutaneous transhepatic route. In both cases, pancreatic fistula was successfully closed within a day. These interventional endoprostheses are very useful for treatment of inactable pancreatic fistula.