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  • Title: Two-staged hepato-pancreatoduodenectomy and interventional pancreaticojejunostomy.
    Author: Cho A, Arita S, Koike N, Isaka N, Kusume K, Okazumi S, Makino H, Tohma T, Matsubara K, Gunji H, Ochiai T.
    Journal: Hepatogastroenterology; 2005; 52(66):1886-8. PubMed ID: 16334800.
    Abstract:
    Two-staged pancreatoduodenectomy, including exteriorization of the pancreatic juice and second-look pancreaticojejunostomy, has been recommended for high-risk patients to avoid pancreatic leakage, which often causes intra-abdominal hemorrhage. We present a new technique of interventional pancreaticojejunostomy under both fluoroscopy and endoscopy without second-look laparotomy. A 77-year-old woman with local recurrence and liver metastasis from colon cancer underwent hepato-pancreatoduodenectomy with the external drainage of pancreatic juice via the pancreatic duct tube without pancreaticojejunostomy. Two months later, the jejunum was punctured with the insertion of a 5-F needle-knife into the pancreatic fistula during endoscopic observation of jejunal lumen, followed by the insertion of two 0.35-inch guidewires into the jejunum and the pancreatic fistula. Finally, a 10-Fr stenting tube was placed between the jejunum and the pancreatic fistula. No complications developed.
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