I. Slavu1, V. Braga1, M. Bărbulescu 1, L. Alecu 1

1General Surgery Clinic, The Clinical Emergency Hospital “Prof. Dr. Agrippa Ionescu”, Bucharest, Romania

Corresponding author: Lucian Alecu 
Phone no. 0040722513768
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We present the case of patient SC aged 44 years who underwent surgery 5 years prior to the presentation to our clinic for a tumor in the head of the pancreas, the operation than consisted of a cephalic duodenopancretectomy which was followed by a number of complications. On admission the patient had abdominal pain in the right flank, giant median postoperative eventration and aexternal ”a la Witzel” biliary drainage tube. Abdominal ultrasound revealed the presence of a interhepaticodiaphragmatic collection that measured 4.6 / 3 cm. A cholangiography was done which showed biliary tract opacification of the left lobe with the full stop of the contrast in the distal left main hepatic duct without intrahepatic biliary dilatation. Surgery was undertaken under total anesthesia – the intraoperative diagnosis consisted of: almost complete stenosis of the bilio-jejunostomy. After the adhesions were cut, the bilio-jejunostomy was redone using the left hepatic duct in a terminal-lateral anastomosis. The collection was drained and the abdominal defect was corrected. The patient maintained a favorable external biliary drainage of about 200 ml per day so in the 5-th postoperative day the drainage was clamped without any complications. Conclusions: 1. Duodenopancreatectomy should be reserved for average / high volume surgical centers. 2. During the intervention the steps to achieve the biliary-digestive anastomosis should be respected thoroughly 3. Fast reoperation may increase the chance of survival of the patient.

Keywords: bilio-jejunostomy, hepatic duct, interhepaticodiaphragmatic collection, chronic pancreatitis

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