BILIO-JEJUNOSTOMY STENOSIS AFTER CEPHALIC-DUODENOPANCREATECTOMY IN CHRONIC PANCREATITIS - CASE REPORT

CLINICAL CASE

  • I. Slavu General Surgery Clinic, The Clinical Emergency Hospital “Prof. Dr. Agrippa Ionescu”, Bucharest, Romania
  • V. Braga General Surgery Clinic, The Clinical Emergency Hospital “Prof. Dr. Agrippa Ionescu”, Bucharest, Romania
  • M. Bărbulescu 1 General Surgery Clinic, The Clinical Emergency Hospital “Prof. Dr. Agrippa Ionescu”, Buc
  • L. Alecu General Surgery Clinic, The Clinical Emergency Hospital “Prof. Dr. Agrippa Ionescu”, Bucharest, Romania
Keywords: bilio-jejunostomy, hepatic duct, interhepaticodiaphragmatic collection, chronic pancreatitis

Abstract

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 a
external ”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 biliojejunostomy.
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.

Published
2015-01-01
How to Cite
[1]
I. Slavu, V. Braga, M. Bărbulescu, and L. Alecu, “BILIO-JEJUNOSTOMY STENOSIS AFTER CEPHALIC-DUODENOPANCREATECTOMY IN CHRONIC PANCREATITIS - CASE REPORT”, JSS, vol. 2, no. 1, pp. 24-28, Jan. 2015.
Section
Articles