Chronic Pancreatitis with Pancreaticopleural Fistula Successfully Treated with Pancreoticoduodenectomy and Fistula Ligation

• Published in: The Japanese Journal of Gastroenterological Surgery Vol. 51; no. 3; pp. 214 - 221
• Main Authors: Sugita, Hiroaki, Terada, Takuro, Tawara, Hiroki, Okude, Teruo, Shimada, Masanari, Saito, Kenichiro, Amaya, Susumu, Takashima, Yoshihiro, Munemoto, Yoshinori, Mitsui, Takeshi
• Format: Journal Article
• Language: Japanese
• Published: The Japanese Society of Gastroenterological Surgery 01.03.2018
• Subjects: chronic pancreatitis; pancreatic pleural effusion; pancreaticopleural fistula
• ISSN: 0386-9768; 1348-9372
• DOI: 10.5833/jjgs.2017.0084

A 47-year-old man was admitted to our hospital due to an acute exacerbation of alcoholic chronic pancreatitis with duodenal stenosis. He recovered with conservative treatment and was discharged. After the hospitalization, he could not stop drinking and needed rehospitalization for recurrent pancreatitis. ERCP showed stenosis of the distal common bile duct and CT revealed left pleural effusion. We diagnosed pancreatic pleural effusion caused by pancreaticopleural fistula, and a thoracic drainage tube was inserted. It was impossible to perform endoscopic pancreatic duct drainage, and common bile duct stenosis and pleural effusion did not improve, so we planned to perform surgery. For chronic pancreatitis and common bile duct stenosis, we performed subtotal stomach-preserving pancreaticoduodenectomy (SSPPD). During the operation, the pancreaticopleural fistula was grossly invisible, but we were able to detect and ligate the fistula by injection of contrast medium and indigo carmine into the cut end of the residual pancreas. For surgery of chronic pancreatitis, it is important to balance curability and functional preservation. We report a case in which intraoperative injection of contrast medium and indigo carmine were useful for ligation of fistula and preservation of residual pancreas.