TWO CASES OF PANCREATIC FISTULA AFTER PANCREATICODUODENECTOMY SUCCESSFULLY CURED BY INTERNAL DRAINAGE UNDER ULTRASONOGRAPHIC GUIDANCE

• Published in: Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) Vol. 66; no. 1; pp. 182 - 186
• Main Authors: SHIMIZU, Sadatoshi, HORII, Katsuhiko, MATSUYAMA, Mitsuharu, TAMAMORI, Yutaka, NAKAZAWA, Kazunori, YAMAZAKI, Osamu
• Format: Journal Article
• Language: English
• Published: Japan Surgical Association 2005
• ISSN: 1345-2843; 1882-5133
• DOI: 10.3919/jjsa.66.182

Pancreatojejunal anastomotic insufficiency still frequently occurs after pancreaticoduodenectomy (PD). It is cured by conservative therapy in most cases, but complete external pancreatic fistula is intractable. We report two cases of intractable pancreatic fistula after PD successfully treated by internal drainage under ultrasonographic guidance. A 78-year-old woman and a 62-year-old man underwent PD for bile duct cancer. Reconstruction was performed by modified Child's method and pancreatojejunal anastomosis was performed by insertion of a stent tube into the main pancreatic duct. In both cases, after removal of the stent tube, pancreatic juice began to leak from the drain. Fistulography showed no communication between the main pancreatic duct and anastomosed jejunum. In order to make the communication between them, puncture was aimed at the elevated jejunum through the sinus tract under ultrasonographic guidance. Internal drainage tube was inserted into the jejunal lumen and placed. About 3 months later, the drainage tube was removed. The fistula was successfully closed in both cases. Internal drainage under ultrasonographic guidance is very useful for treatment of intractable pancreatic fistula.