Stenosis of pancreaticogastrostomy after pancreaticoduodenectomy (a case report)

Authors

DOI:

https://doi.org/10.14739/2310-1210.2022.3.246220

Keywords:

pancreatico­duodenectomy, neopancreatico­gastrostomy

Abstract

Formation of the pancreaticodigestive anastomosis after pancreaticoduodenectomy (PD) is the “Achilles’ heel” of this operation. Early postoperative complications are well known and well described in the scientific literature, but there are few works on late postoperative complications. Stenosis of pancreaticodigestive anastomoses are rarely mentioned, and the vast majority of publications are focused on stenosis of pancreaticojejunostomy. Regarding stenosis of pancreaticogastrostomy, there are only a few publications of clinical cases in the English-language literature.

The aim of the work was to analyze the case of stenosis of pancreaticogastrostomy after PD.

Results. The article presents a clinical case of pancreaticogastrostomy stenosis in a patient 5.5 months after PD. The study included the analysis of inpatient and outpatient charts, data of clinical, laboratory and instrumental examinations. Features of the pancreaticogastrostomy formation in clinic are listed, complaints of the patient during the development of stenosis are revealed, results of additional methods of diagnostics and also operative treatment – neopancreaticogastrostomy that was carried out are described in detail.

Conclusions. Stenosis of pancreaticogastrostomy is a rare and little-studied late complication of pancreaticoduodenectomy. The clinical course of the pancreaticogastrostomy stenosis, the results of laboratory and instrumental methods did not allow to state with certainty the diagnosis of acute pancreatitis. The formation of neopancreaticogastrostomy is the operation of choice for the described pathology treatment.

Author Biographies

O. B. Kutovyi, Dnipro State Medical University, Dnipro, Ukraine

MD, PhD, DSc, Professor, Head of the Department of Surgery 2

К. О. Denysova, Dnipro State Medical University, Dnipro, Ukraine

MD, Postgraduate student of the Department of Surgery 2

References

Bhagwandin, S., & Salti, G. (2016). Post pancreaticoduodenectomy anastomotic stricture with recurrent pancreatitis treated with longitudinal pancreaticogastrostomy. HPB, 18(Suppl. 1), E590. https://doi.org/10.1016/j.hpb.2016.03.573

Di Martino, M., de la Hoz Rodríguez, Á., & Martín-Pérez, E. (2020). Blumgart pancreaticojejunostomy: does it reduce postoperative pancreatic fistula in comparison to other pancreatic anastomoses? Annals of Translational Medicine, 8(12), Article 736. https://doi.org/10.21037/atm.2020.03.185

Reddy, J. R., Saxena, R., Singh, R. K., Pottakkat, B., Prakash, A., Behari, A., Gupta, A. K., & Kapoor, V. K. (2012). Reoperation following Pancreaticoduodenectomy. International Journal of Surgical Oncology, 2012, Article 218248. https://doi.org/10.1155/2012/218248

Justo Alonso, I., Marcacuzco Quinto, A., Caso Maestro, O., & Jiménez-Romero, C. (2018). Reconstrucción anastomótica y drenaje externo del conducto de Wirsung como tratamiento de la estenosis pancreato-yeyunal posduodenopancreatectomía cefálica. Cirugía Española, 96(10), 648-652. https://doi.org/10.1016/j.ciresp.2018.08.003

Kuwatani, M., Kato, S., & Sakamoto, N. (2019). Direct recanalization of pancreaticogastrostomy obstruction with a forward-viewing echoendoscope. Digestive Endoscopy, 31(1), e18-e19. https://doi.org/10.1111/den.13284

Lyu, Y., Li, T., Cheng, Y., Wang, B., Chen, L., & Zhao, S. (2018). Pancreaticojejunostomy Versus Pancreaticogastrostomy After Pancreaticoduodenectomy: An Up-to-date Meta-analysis of RCTs Applying the ISGPS (2016) Criteria. Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, 28(3), 139-146. https://doi.org/10.1097/SLE.0000000000000530

Mucci-Hennekinne, S., Brachet, D., Clouston, H., Pessaux, P., Hamy, A., & Arnaud, J. P. (2007). Management of a stenotic pancreatico-digestive tract anastomosis following pancreatoduodenectomy. Journal of Hepato-Biliary-Pancreatic Surgery, 14(5), 514-517. https://doi.org/10.1007/s00534-006-1204-3

Parra-Membrives, P., Martínez-Baena, D., & Sánchez-Sánchez, F. (2016). Late Biliary Complications after Pancreaticoduodenectomy. The American Surgeon, 82(5), 456-461.

Pugalenthi, A., Protic, M., Gonen, M., Kingham, T. P., Angelica, M. I., Dematteo, R. P., Fong, Y., Jarnagin, W. R., & Allen, P. J. (2016). Postoperative complications and overall survival after pancreaticoduodenectomy for pancreatic ductal adenocarcinoma. Journal of Surgical Oncology, 113(2), 188-193. https://doi.org/10.1002/jso.24125

Schorn, S., Demir, I. E., Vogel, T., Schirren, R., Reim, D., Wilhelm, D., Friess, H., & Ceyhan, G. O. (2019). Mortality and postoperative complications after different types of surgical reconstruction following pancreaticoduodenectomy - a systematic review with meta-analysis. Langenbeck's Archives of Surgery, 404(2), 141-157. https://doi.org/10.1007/s00423-019-01762-5

Yen, H. H., Ho, T. W., Wu, C. H., Kuo, T. C., Wu, J. M., Yang, C. Y., & Tien, Y. W. (2019). Late acute pancreatitis after pancreaticoduodenectomy: incidence, outcome, and risk factors. Journal of Hepato-Biliary-Pancreatic Sciences, 26(3), 109-116. https://doi.org/10.1002/jhbp.606

Liu, Y. (Ed.). (2020). Surgical Atlas of Pancreatic Cancer. Springer, Singaporee. https://doi.org/10.1007/978-981-32-9864-4

Zarzavadjian Le Bian, A., Cesaretti, M., Tabchouri, N., Wind, P., & Fuks, D. (2018). Late Pancreatic Anastomosis Stricture Following Pancreaticoduodenectomy: a Systematic Review. Journal of Gastrointestinal Surgery, 22(11), 2021-2028. https://doi.org/10.1007/s11605-018-3859-x

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Published

2022-05-30

How to Cite

1.
Kutovyi OB, Denysova КО. Stenosis of pancreaticogastrostomy after pancreaticoduodenectomy (a case report). Zaporozhye medical journal [Internet]. 2022May30 [cited 2024Apr.26];24(3):365-9. Available from: http://zmj.zsmu.edu.ua/article/view/246220

Issue

Vol. 24 No. 3 (2022)

Section

Case Reports

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