Pancreatic Fistula After Pancreaticoduodectomy: The Endoscopic Retroperitoneoscopy Approach

Abstract Text Pancreaticojejunal anastomosis (PJA) dehiscence and necrosis with peritoneal collection (PC) represent a challenging complication of pancreatic surgery. This is the case of a 65-year-old male patient after pylorus preserving pancreaticoduodectomy. PC drainage was performed by placing a Niti-S™ NAGI™ stent (12mm x 20mm) across the dehiscence. Seven days later, previous CT-scan confirmation of PC resolution and because of stent proximity to the splenic vein, the NAGI was endoscopically removed. The tip of the colonoscope was gently pushed in order to perform a retroperitoneoscopy which allowed to cannulate the main duct of the residual post-surgical edematous pancreatic tail; a fc-SEMS (6mm x 80mm) was placed to drain the pancreatic juice in the jejunal limb far away from the PJA. Three months later the fc-SEMS was removed. To date, the patient is asymptomatic [1] [2].

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Publication History

Article published online:
27 March 2025

• References

• 1 Mutignani M, Dokas S, Tringali A. et al. Pancreatic Leaks and Fistulae: An Endoscopy-Oriented Classification. Dig Dis Sci 2017; 62 (10): 2648-57
• 2 Meierhofer C, Fuegger R, Spaun GO. et al. Endoscopic Transmural Therapy of Pancreatic Fistulas in an Interdisciplinary Setting-A Retrospective Data Analysis. J Clin Med 2023; 12 (13): 4531