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| Deliberate external pancreatic fistula after pancreaticoduodenectomy performed in the setting of acute pancreatitis, and its internalization through fistula-jejunostomy |
| Sorin T Alexandrescu a , b , ∗, Andrei C Zlate a , Razvan T Grigorie a , Mihnea Ionescu a , Irinel Popescu a , c |
a Fundeni Clinical Institute, Dan Setlacec Centre of General Surgery and Liver Transplantation, Sos. Fundeni nr. 258, sector 2, Bucharest, Romania
b Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
c Titu Maiorescu University, Faculty of Medicine, Bucharest, Romania
∗ Corresponding author at: Fundeni Clinical Institute, Dan Setlacec Centre of General Surgery and Liver Transplantation, Sos. Fundeni nr. 258, sector 2, Bucharest, Romania.
E-mail address: stalexandrescu@yahoo.com (S.T. Alexandrescu). |
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Abstract Many patients with tumors of the pancreatic head or of the ampulla of Vater require endoscopic manipulation of the duodenal papilla in order to achieve tumor biopsy or for common bile duct stenting. These interventional endoscopy approaches may lead to acute pancreatitis. The iatrogenic acute pancreatitis will influence the surgical strategy in patients scheduled for pancreaticoduodenectomy (PD). Due to the small number of cases, the surgical strategy in patients who require PD in the context of acute pancreatitis has not been standardized. The most meaningful strategy is to postpone the operation until clinic, enzymatic and radiologic remission of the pancreatitis is achieved. Even when these criteria are fulfilled, sometimes, during laparotomy one can observe the persistence of steatonecrosis (small foci of necrosis of the fatty tissue around the pancreas) and edema of the pancreas. In such instances, because of the pancreatic stump pancreatitis, the risk of pancreato-jejunal/gastric (PJA/PGA) anastomosis postoperative leak is extremely high [1] . Therefore, avoidance of the pancreatic anastomosis during PD and the performance of an external drainage of the pancreatic stump may represent an option, assuming the formation of a deliberate external pancreatic fistula. Afterwards, the internalization of the fistula can be performed during a second operation, usually by a pancreato-jejunostomy (“two stage” PD) [2] .
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2020, Vol. 19 
